CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: HCA Florida Twin Cities Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $5,628
Cash Discount Price: $18,760
vs. Medicare Baseline: 52.69x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at HCA Florida Twin Cities Hospital is $5,628. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $18,760. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 52.69x the Medicare baseline. Located in 2190 Hwy 85 N, Niceville, FL.

Cash / Self-Pay

$18,760

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,628

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: $18,760 (17564%)

Insurance Median: $5,628 (5269%)

Cash: $18,760 (17564% of Medicare)

Ins. Median: $5,628 (5269% 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 5269% of the Medicare baseline (a markup of 5169%). 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
United	$245 - $8,442	229%
Avmed	$1,695 - $9,380	1587%
Aetna	$1,696 - $5,628	1588%
Corvel Corporation	$2,335	2186%
Prime Health	$2,384	2232%
Careworks (Rockport Community)	$2,458	2301%
Simply	$2,889	2705%
Molina Healthcare	$3,564 - $6,003	3337%
Sunshine State Health Plan	$4,784	4479%
Plotkin Health	$9,380	8782%
Prime Health Sheriff	$9,380	8782%
Evolutions Healthcare	$12,194 - $15,946	11417%
Multiplan	$14,633 - $15,946	13700%
Ppo Next	$15,946	14929%
Novanet	$16,884	15808%

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 $18,760.
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 HCA Florida Twin Cities Hospital 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.