CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Shenandoah Medical Center

Billing Code: 72131 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$399

about 3.7× the $107 Medicare rate · typically $123–$1,382

modeled estimate · not a bill or quote

What this hospital charges insurers

$162

Below the fair price — a good deal

about $237 under the fair price · 1.5× Medicare

Medicare pays $107 Fair price $399 This hospital $162 Cash price $1,340 Hospital's list price $2,061

How we calculate the fair BaseRate →

How this hospital compares to other IA hospitals

Highest price of the 9 IA hospitals we have prices for — worth calling around.

Cheapest $44 Priciest $162

Black dot = this hospital, among the 9 IA hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a CT scan, lower back (lumbar spine) is about $399 (about 3.7× the $107 Medicare rate). Shenandoah Medical Center charges insurers about $162, or about $1,340 in cash — below the fair price — a good deal. Located in Shenandoah, IA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

3 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna CignaHumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$107 - $2,020	100%
Blue Cross Blue Shieldmajor	$162	152%
Aetnamajor	$701 - $1,979	656%
Amerigroup	$694	650%
Molina	$680 - $701	637%
WellCare	$701	656%
+ 3 smaller / regional plans	$680 - $687

Government programs also on file: Military & VA.

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 1,340), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 72131.

Insurance Before you use insurance

Call your insurance company to confirm Shenandoah Medical Center is in-network.
Ask your insurer whether prior approval is required for CPT code 72131.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Shenandoah Medical Center

Compare: CT scan, lower back (lumbar spine) at other IA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.