CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Upland Hills Health

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $836
Cash Discount Price: $937
vs. Medicare Baseline: 7.83x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Upland Hills Health is $836. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $937. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.83x the Medicare baseline. Located in 800 Compassion Way, Dodgeville, WI.

Cash / Self-Pay

$937

Average discount available for prompt cash payment at this facility.

Insurance Median

$836

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: $937 (877%)

Insurance Median: $836 (783%)

Cash: $937 (877% of Medicare)

Ins. Median: $836 (783% 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 783% of the Medicare baseline (a markup of 683%). 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	$106 - $494	99%
Ghc Of Eau Claire	$143	134%
Ghc Of Sc Wi	$143 - $2,030	134%
Mhs	$143 - $836	134%
Humana	$164 - $2,687	154%
Dean Health Plan	$235 - $2,077	220%
Alliance	$325 - $1,688	304%
Blue Cross Blue Shield	$836 - $2,448	783%
Icare	$836	783%
Medical Associates	$836 - $1,025	783%
Security Health Plan	$836	783%
Quartz	$1,004	940%
Wps	$1,821 - $1,878	1705%
Cigna	$2,227 - $2,490	2085%
Multiplan	$2,628	2460%

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 $937.
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 Upland Hills Health 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.