CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Marshfield Medical Center - Rice Lake

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,181
Cash Discount Price: $1,175
vs. Medicare Baseline: 11.06x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Marshfield Medical Center - Rice Lake is $1,181. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,175. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 11.06x the Medicare baseline. Located in 1700 West Stout Street, Rice Lake, WI.

Cash / Self-Pay

$1,175

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,181

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: $1,175 (1100%)

Insurance Median: $1,181 (1106%)

Cash: $1,175 (1100% of Medicare)

Ins. Median: $1,181 (1106% 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 1106% of the Medicare baseline (a markup of 1006%). 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
UnitedHealthcare	$585 - $1,019	548%
Family Health Center (Fhc)	$618	579%
Amish/Mennonite	$680	637%
Sanford Health Plan	$680	637%
Group Health Cooperative Of Eau Claire	$1,014 - $1,188	949%
Molina Healthcare Of Wi	$1,051	984%
The Alliance	$1,169 - $1,645	1094%
Besse Forest Products	$1,175	1100%
Cigna	$1,175	1100%
Corvel	$1,175	1100%
First Health	$1,175	1100%
Health Partners	$1,175	1100%
Healtheos By Multiplan Inc.	$1,175	1100%
Rice Lake School District	$1,175	1100%
Medica Of Wi	$1,181 - $1,205	1106%
Trilogy	$1,181 - $1,188	1106%
Coventry	$1,188	1112%
Health Smart	$1,188	1112%
Rising Medical Work Comp	$1,200	1123%
Wps Health Insurance	$1,206	1129%
Three Rivers Provider Network (Trpn)	$1,212	1135%
Security Health Plan (Shp)	$1,286 - $1,758	1204%
Blue Cross Blue Shield	$1,608 - $1,837	1505%

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 $1,175.
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 Marshfield Medical Center - Rice Lake 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.