CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Sanford Thief River Falls Medical Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,801
Cash Discount Price: $2,286
vs. Medicare Baseline: 16.86x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Sanford Thief River Falls Medical Center is $1,801. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,286. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 16.86x the Medicare baseline. Located in 3001 Sanford Parkway, Thief River Falls, MN.

Cash / Self-Pay

$2,286

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,801

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $2,286 (2140%)

Insurance Median: $1,801 (1686%)

Cash: $2,286 (2140% of Medicare)

Ins. Median: $1,801 (1686% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 1686% of the Medicare baseline (a markup of 1586%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Primewest	$112 - $1,200	105%
Ucare	$112 - $2,511	105%
Blue Cross Blue Shield	$353 - $1,178	330%
Sanford Health Plan Align	$1,086	1017%
Aetna	$1,178 - $2,484	1103%
Health Partners	$1,178 - $2,315	1103%
Medicare (plans)	$1,178	1103%
UnitedHealthcare	$1,178 - $2,386	1103%
Sanford Health Plan	$1,531 - $1,801	1433%
Security Health Plan	$1,572	1472%
Medica	$2,512 - $2,704	2352%
Cigna	$2,572	2408%
First Choice Health Network	$2,572	2408%
Healthez	$2,572	2408%
Multiplan	$2,572	2408%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $2,286.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72131.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Sanford Thief River Falls Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72131.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.