CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: St Josephs Community Hospital West Bend

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,903
Cash Discount Price: $1,662
vs. Medicare Baseline: 17.82x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at St Josephs Community Hospital West Bend is $1,903. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,662. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 17.82x the Medicare baseline. Located in 3200 Pleasant Valley Road, West Bend, WI.

Cash / Self-Pay

$1,662

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,903

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: $1,662 (1556%)

Insurance Median: $1,903 (1782%)

Cash: $1,662 (1556% of Medicare)

Ins. Median: $1,903 (1782% 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 1782% of the Medicare baseline (a markup of 1682%). 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
Allwell	$103	96%
Blue Cross Blue Shield	$103 - $2,568	96%
Community Care	$103	96%
Health Partners	$103 - $1,964	96%
Humana	$103	96%
Icare	$103	96%
Molina	$103	96%
Network Health Plan	$103 - $1,033	96%
Security Health Plan Secure Savers	$103	96%
UnitedHealthcare	$103 - $1,565	96%
Aetna	$105 - $2,115	98%
Care Wisconsin	$106	99%
Centivo	$906 - $997	848%
Froedtert South	$1,269	1188%
Chorus Community Health Plan	$1,299	1216%
Sheboygan Employers Health Network	$1,791	1677%
Common Ground	$1,813	1697%
Health Payment Systems	$1,903 - $2,442	1782%
Wisconsin Physician Services	$2,417	2263%
Trilogy	$2,477	2319%
Americas Choice	$2,628	2460%
Healtheos	$2,628	2460%
Multiplan/Private Healthcare Systems	$2,628	2460%
First Health Network	$2,658	2489%
Hfn	$2,719	2546%
Ibsi Passport	$2,719	2546%
Cigna	$2,870	2687%
Healthsmart	$2,870	2687%

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 $1,662.
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 St Josephs Community Hospital West Bend 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.