CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Sanford Medical Center Bismarck

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,128
Cash Discount Price: $1,284
vs. Medicare Baseline: 10.56x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Sanford Medical Center Bismarck is $1,128. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,284. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 10.56x the Medicare baseline. Located in 300 N 7Th St, Bismarck, ND.

Cash / Self-Pay

$1,284

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,128

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: $1,284 (1202%)

Insurance Median: $1,128 (1056%)

Cash: $1,284 (1202% of Medicare)

Ins. Median: $1,128 (1056% 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 1056% of the Medicare baseline (a markup of 956%). 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
Sanford Health Plan Align	$101	95%
Ucare	$108 - $1,160	101%
Aetna	$110 - $1,358	103%
Blue Cross Blue Shield	$110	103%
Health Partners	$110 - $738	103%
Medicare (plans)	$110	103%
UnitedHealthcare	$110 - $1,332	103%
Primewest	$112	105%
Sanford Health Plan	$132	124%
Security Health Plan	$883	827%
Medica	$1,093 - $1,170	1023%
Cigna	$1,444	1352%
First Choice Health Network	$1,444	1352%
Healthez	$1,444	1352%
Multiplan	$1,444	1352%

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 $1,284.
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 Medical Center Bismarck 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.