CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Midwest Orthopedic Specialty Hospital

Billing Code: 72131 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$276

about 2.6× the $107 Medicare rate · typically $123–$312

modeled estimate · not a bill or quote

What this hospital charges insurers

$245

Below the fair price — a good deal

about $31 under the fair price · 2.3× Medicare

Medicare pays $107 Fair price $276 This hospital $245 Cash price $842 Hospital's list price $1,588

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 $245

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 $276 (about 2.6× the $107 Medicare rate). Midwest Orthopedic Specialty Hospital charges insurers about $245, or about $842 in cash — below the fair price — a good deal. Located in Franklin, WI.

What each insurance company pays

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

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

✓ UnitedHealthcare✓ Cigna Blue Cross Blue ShieldAetnaHumanaKaiser 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	$245	229%
Cignamajor	$1,239	1160%
+ 2 smaller / regional plans	$145 - $724

Government programs also on file: Medicare, Military & VA.

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 842), 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 Midwest Orthopedic Specialty Hospital 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 Midwest Orthopedic Specialty Hospital

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

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