CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: HCA Florida Jfk Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $2,927
Cash Discount Price: $18,291
vs. Medicare Baseline: 27.40x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at HCA Florida Jfk Hospital is $2,927. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $18,291. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 27.40x the Medicare baseline. Located in 5301 S Congress Ave, Atlantis, FL.

Cash / Self-Pay

$18,291

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,927

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: $18,291 (17125%)

Insurance Median: $2,927 (2740%)

Cash: $18,291 (17125% of Medicare)

Ins. Median: $2,927 (2740% 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 2740% of the Medicare baseline (a markup of 2640%). 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 - $8,231	229%
Healthy Palm Beaches	$550	515%
Aetna	$868 - $5,487	813%
Avmed	$890 - $9,146	833%
Freedom Health	$1,573 - $2,927	1473%
Optimum	$1,573	1473%
Simply Healthcare Plans	$2,378	2226%
Corvel Corporation	$2,426	2271%
Careworks (Rockport)	$2,477	2319%
Prime Health	$2,477	2319%
Molina	$3,109 - $4,939	2911%
Health Sun Health Plan	$3,896	3648%
Aids Healthcare	$4,024 - $21,949	3767%
Mmm Of Fl (Health Advantage Plan)	$4,207	3939%
United Ppo	$4,335	4059%
Sunshine State Health Plan	$4,756	4453%
Blis	$6,402	5994%
District Cares	$9,146	8563%
Plotkin Health	$9,146	8563%
Prime Health Sherriff	$9,146	8563%
Medica Healthcare	$10,792	10104%
Multiplan	$13,718 - $15,547	12843%
Evernorth Bh	$14,633	13700%

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 $18,291.
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 Jfk 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.