CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Gundersen St Josephs Hospital and Clinics

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,670
Cash Discount Price: $1,382
vs. Medicare Baseline: 15.64x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Gundersen St Josephs Hospital and Clinics is $1,670. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,382. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 15.64x the Medicare baseline. Located in 400 Water Ave, Hillsboro, WI.

Cash / Self-Pay

$1,382

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,670

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: $1,382 (1294%)

Insurance Median: $1,670 (1564%)

Cash: $1,382 (1294% of Medicare)

Ins. Median: $1,670 (1564% 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 1564% of the Medicare baseline (a markup of 1464%). 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
Amerigroup	$46	43%
Blue Cross Blue Shield	$282 - $2,313	264%
Iowa Total Care	$282	264%
Managed Health Service	$282	264%
Security Health Plan	$467	437%
Ucare	$1,237 - $1,903	1158%
UnitedHealthcare	$1,261 - $1,663	1181%
Quartz	$1,297	1214%
Alliance	$1,678 - $2,019	1571%
Cigna	$1,951	1827%
Aspirus Arise Health	$1,975	1849%
Humana	$2,022	1893%
Multiplan/Healtheos	$2,070 - $2,260	1938%
Coventry Health Care	$2,260	2116%

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 $1,382.
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 Gundersen St Josephs Hospital and Clinics 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.