CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Gundersen St Josephs Hospital and Clinics

Billing Code: 72131 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$565

about 5.3× the $107 Medicare rate · typically $113–$1,760

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,678

Well above the fair price

about $1,113 over the fair price · 15.7× Medicare

Medicare pays $107 Fair price $565 This hospital $1,678 Cash price $1,382 Hospital's list price $2,379

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

Highest price of the 9 WI hospitals we have prices for — worth calling around.

Cheapest $51 Priciest $1,678

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

A fair price for a CT scan, lower back (lumbar spine) is about $565 (about 5.3× the $107 Medicare rate). Gundersen St Josephs Hospital and Clinics charges insurers about $1,678, or about $1,382 in cash — well above the fair price. Located in Hillsboro, WI.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $565. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$1,261 - $1,663	1181%
Blue Cross Blue Shieldmajor	$282 - $2,313	264%
Aetnamajor	$2,260	2116%
Cignamajor	$1,951	1827%
Humanamajor	$2,022	1893%
Amerigroup	$46	43%
Quartz	$1,297	1214%
Security Health Plan	$467	437%
UCare	$1,237 - $1,903	1158%
+ 4 smaller / regional plans	$282 - $2,019

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 1,382), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 72131.

Insurance Before you use insurance

Call your insurance company to confirm Gundersen St Josephs Hospital and Clinics is in-network.
Ask your insurer whether prior approval is required for CPT code 72131.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Gundersen St Josephs Hospital and Clinics

Compare: CT scan, lower back (lumbar spine) at other WI hospitals

Insurance negotiated median for the same procedure, sorted lowest first.