CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Gillette Childrens Specialty Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,630
Cash Discount Price: $1,824
vs. Medicare Baseline: 15.26x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Gillette Childrens Specialty Hospital is $1,630. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,824. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 15.26x the Medicare baseline. Located in 200 University Avenue East, Saint Paul, MN.

Cash / Self-Pay

$1,824

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,630

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: $1,824 (1708%)

Insurance Median: $1,630 (1526%)

Cash: $1,824 (1708% of Medicare)

Ins. Median: $1,630 (1526% 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 1526% of the Medicare baseline (a markup of 1426%). 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
Ucare	$34 - $1,216	32%
Health Partners	$70 - $2,204	66%
UnitedHealthcare	$79 - $1,818	74%
Medica	$85 - $2,250	80%
Blue Cross Blue Shield	$89 - $2,144	83%
Aetna	$111 - $2,280	104%
Humana	$1,824	1708%
America'S Ppo	$2,432	2277%
Geha	$2,584	2419%
Multiplan	$2,584	2419%

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 $1,824.
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 Gillette Childrens Specialty Hospital 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.