CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Cherokee Regional Medical Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,230
Cash Discount Price: $1,107
vs. Medicare Baseline: 11.52x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Cherokee Regional Medical Center is $1,230. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,107. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 11.52x the Medicare baseline. Located in 300 Sioux Valley Drive, Cherokee, IA.

Cash / Self-Pay

$1,107

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,230

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: $1,107 (1036%)

Insurance Median: $1,230 (1152%)

Cash: $1,107 (1036% of Medicare)

Ins. Median: $1,230 (1152% 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 1152% of the Medicare baseline (a markup of 1052%). 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
Health Partners	$652 - $1,230	610%
UnitedHealthcare	$652 - $1,230	610%
Wellpoint	$652 - $1,230	610%
Iowa Total Care	$676 - $1,230	633%
Molina	$676 - $1,230	633%
Admin Concepts	$1,230	1152%
Aetna	$1,230	1152%
American Republic	$1,230	1152%
Apw	$1,230	1152%
Auxiant	$1,230	1152%
Avera	$1,230	1152%
Bankers Life	$1,230	1152%
Blue Cross Blue Shield	$1,230	1152%
Champus	$1,230	1152%
Cigna	$1,230	1152%
Humana	$1,230	1152%
Liability	$1,230	1152%
Meridian	$1,230	1152%
Meritain	$1,230	1152%
Midlands	$1,230	1152%
Mutual Of Omaha	$1,230	1152%
Occunet	$1,230	1152%
Physicians Mutual	$1,230	1152%
Private Healthcare	$1,230	1152%
Sanford	$1,230	1152%
United American	$1,230	1152%

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 $1,107.
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 Cherokee Regional Medical 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.