CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Stoughton Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,466
Cash Discount Price: $1,832
vs. Medicare Baseline: 13.73x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Stoughton Hospital is $1,466. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,832. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 13.73x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$1,832

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,466

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: $1,832 (1715%)

Insurance Median: $1,466 (1373%)

Cash: $1,832 (1715% of Medicare)

Ins. Median: $1,466 (1373% 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 1373% of the Medicare baseline (a markup of 1273%). 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
Medicaid / KanCare	$128	120%
Dean Health Insurance Comm - All Other Plans	$536	502%
Dean Health Insurance Epo	$536	502%
Tricare	$793	742%
Healthnet Mcr Adv - All Plans	$886	830%
Dean Health Insurance Med Adv	$933	874%
Humana	$933 - $2,998	874%
Quartz Mcr Adv	$933	874%
Security Health/First Health - All Plans	$933	874%
Aetna	$999 - $2,831	935%
UnitedHealthcare	$1,466 - $2,665	1373%
Quartz Health Solutions - All Other Lans	$1,660	1554%
Geha - All Plans	$2,498	2339%
Cigna	$2,665	2495%
Wisconsin Ppo Ppa Direct - All Plans	$2,665	2495%
Blue Cross Blue Shield	$2,898	2713%
Wps - All Plans	$2,998	2807%
Alliance - All Plans	$13,324	12474%

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 $1,832.
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 Stoughton Hospital 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.