CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Thedacare Regional Medical Center - Appleton Inc

Billing Code: 72131 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$237

about 2.2× the $107 Medicare rate · typically $132–$394

modeled estimate · not a bill or quote

What this hospital charges insurers

$272

About the fair price

about $35 over the fair price · 2.5× Medicare

Medicare pays $107 Fair price $237 This hospital $272 Cash price $1,088 Hospital's list price $1,943

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

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

Cheapest $51 Priciest $272

Black dot = this hospital, among the 9 WI 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 $237 (about 2.2× the $107 Medicare rate). Thedacare Regional Medical Center - Appleton Inc charges insurers about $272, or about $1,088 in cash — about the fair price. Located in Appleton, WI.

What each insurance company pays

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

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

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser 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	$46 - $272	43%
Blue Cross Blue Shieldmajor	$100 - $1,457	94%
Aetnamajor	$1,499 - $1,574	1403%
Cignamajor	$1,430	1339%
Humanamajor	$102	95%
HealthPartners	$242	227%
+ 1 smaller / regional plan	$1,205

Government programs also on file: Medicare.

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 1,088), 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 Thedacare Regional Medical Center - Appleton Inc 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 Thedacare Regional Medical Center - Appleton Inc

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

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