CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Southwest Health Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $2,037
Cash Discount Price: $2,033
vs. Medicare Baseline: 19.07x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Southwest Health Center is $2,037. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,033. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 19.07x the Medicare baseline. Located in 1400 East Side Rd, Platteville, WI.

Cash / Self-Pay

$2,033

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,037

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: $2,033 (1903%)

Insurance Median: $2,037 (1907%)

Cash: $2,033 (1903% of Medicare)

Ins. Median: $2,037 (1907% 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 1907% of the Medicare baseline (a markup of 1807%). 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
Dean Health Plan	$583	546%
Blue Cross Blue Shield	$686 - $3,134	642%
Care Wisconsin	$686 - $2,037	642%
UnitedHealthcare	$709 - $2,570	664%
Quartz	$1,419 - $2,445	1329%
Cigna	$1,716 - $2,350	1607%
Wps	$1,716 - $2,350	1607%
Group Health Cooperative of Sc	$1,830 - $2,727	1713%
Humana	$2,059 - $2,821	1928%
Healthchoice	$2,174 - $2,977	2035%
Group Health Eau Claire	$2,288 - $3,134	2142%
Group Health South Central	$2,288 - $3,134	2142%

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 $2,033.
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 Southwest Health Center 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.