CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: South Miami Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $2,374
Cash Discount Price: $3,391
vs. Medicare Baseline: 22.23x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at South Miami Hospital is $2,374. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,391. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 22.23x the Medicare baseline. Located in 6200 Sw 73Rd St, Miami, FL.

Cash / Self-Pay

$3,391

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,374

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: $3,391 (3175%)

Insurance Median: $2,374 (2223%)

Cash: $3,391 (3175% of Medicare)

Ins. Median: $2,374 (2223% 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 2223% of the Medicare baseline (a markup of 2123%). 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
Amerigroup	$65	61%
Medicaid / KanCare	$65 - $72	61%
Sunshine State	$69	65%
UnitedHealthcare	$69 - $5,384	65%
Wellcare	$69	65%
Aetna	$71 - $4,307	66%
Vista	$71	66%
Medicare (plans)	$109 - $147	102%
Blue Cross Blue Shield	$113 - $3,489	106%
Medica Health Plan	$117	110%
Humana	$119	111%
Avmed	$120 - $2,665	112%
Leon Medical	$120	112%
Cigna	$124 - $4,307	116%
Non Contracted	$1,853 - $1,976	1735%
Amerihealth	$2,272 - $2,423	2127%
International	$3,282 - $3,500	3073%
Dimension Health Plan	$3,788 - $4,846	3546%
Affordable	$4,292 - $4,576	4018%
Phcs	$4,545 - $4,846	4255%
Quality Health	$4,545 - $4,846	4255%

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 $3,391.
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 South Miami 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.