CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Sanford Vermillion Medical Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,779
Cash Discount Price: $2,018
vs. Medicare Baseline: 16.66x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Sanford Vermillion Medical Center is $1,779. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,018. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 16.66x the Medicare baseline. Located in 20 South Plum Street, Vermillion, SD.

Cash / Self-Pay

$2,018

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,779

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: $2,018 (1889%)

Insurance Median: $1,779 (1666%)

Cash: $2,018 (1889% of Medicare)

Ins. Median: $1,779 (1666% 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 1666% of the Medicare baseline (a markup of 1566%). 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	$744	697%
Wellmark Sd	$767	718%
Ucare	$822 - $2,217	770%
Aetna	$833 - $2,192	780%
Health Partners	$833 - $1,892	780%
Medicare (plans)	$833	780%
UnitedHealthcare	$833 - $2,107	780%
Primewest	$848	794%
Sanford Health Plan	$999 - $1,340	935%
Security Health Plan	$1,388	1300%
Medica	$2,081 - $2,225	1948%
Wellmark	$2,170 - $2,195	2032%
First Choice Health Network	$2,271	2126%
Healthez	$2,271	2126%
Multiplan	$2,271	2126%

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 $2,018.
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 Vermillion 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.