CMS Price Transparency Data

Trauma team activation

Facility: Sanford Westbrook Medical Center

Billing Code: G0390 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0390
Insurance Median: $2,678
Cash Discount Price: $2,566
vs. Medicare Baseline: 1.97x Medicare

The contracted insurance negotiated median rate for a Trauma team activation at Sanford Westbrook Medical Center is $2,678. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,566. Compared to the federal Medicare reimbursement reference rate of $1,361.78, this hospital’s rate is 1.97x the Medicare baseline. Located in 920 Bell Avenue Po Box 188, Westbrook, MN.

Cash / Self-Pay

$2,566

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,678

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$1,361.78

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $1,361.78 (100%)

Cash / Self-Pay: $2,566 (188%)

Insurance Median: $2,678 (197%)

Cash: $2,566 (188% of Medicare)

Ins. Median: $2,678 (197% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $1,361.78 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.

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
Blue Cross Blue Shield	$776 - $2,967	57%
Sanford Health Plan Align	$1,373	101%
Ucare	$1,389 - $2,818	102%
Wellmark Sd	$1,472	108%
Health Partners	$1,488 - $2,566	109%
Aetna	$1,488 - $2,787	109%
UnitedHealthcare	$1,488 - $2,678	109%
Medicare (plans)	$1,488	109%
Primewest	$1,515 - $1,623	111%
Security Health Plan	$1,764	130%
Sanford Health Plan	$2,532 - $2,978	186%
Medica	$2,819 - $3,034	207%
First Choice Health Network	$2,886	212%
Cigna	$2,886	212%
Healthez	$2,886	212%
Multiplan	$2,886	212%

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 $2,566.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G0390.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Sanford Westbrook Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code G0390.
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.