CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: HCA Florida Sarasota Doctors Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $3,062
Cash Discount Price: $19,881
vs. Medicare Baseline: 28.67x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at HCA Florida Sarasota Doctors Hospital is $3,062. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $19,881. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 28.67x the Medicare baseline. Located in 5731 Bee Ridge Rd, Sarasota, FL.

Cash / Self-Pay

$19,881

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,062

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: $19,881 (18613%)

Insurance Median: $3,062 (2867%)

Cash: $19,881 (18613% of Medicare)

Ins. Median: $3,062 (2867% 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 2867% of the Medicare baseline (a markup of 2767%). 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 - $8,946	229%
Avmed	$738 - $1,863	691%
Aetna	$848 - $5,964	794%
Access 2 Healthcare Physicians Freedom Optimum Group Members	$934	874%
Access 2 Healthcare Physicians Freedom Health	$1,431	1340%
Access 2 Healthcare Physicians Optimum	$1,431	1340%
Freedom Health Care	$1,551	1452%
Optimum Healthcare	$1,551	1452%
Corvel Corporation	$2,345	2195%
Rockport Healthcare Group	$2,345	2195%
Prime Health	$2,394	2241%
Simply Healthcare	$3,062	2867%
Molina	$3,777 - $5,368	3536%
Sunshine State Health Plan	$5,070	4747%
Behealthy America	$7,754	7260%
Beacon Health Options	$9,940	9306%
Plotkin Health	$9,940	9306%
Prime Health Sheriff	$9,940	9306%
Evolutions Healthcare Systems	$10,934 - $18,290	10237%
Multiplan	$14,911 - $16,899	13960%
Evernorth	$15,905	14891%

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 $19,881.
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 Sarasota Doctors 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.