CMS Price Transparency Data
CT scan, lower back (lumbar spine)
Facility: Palmetto General Hospital
Billing Code: 72131 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 72131
- Insurance Median: $137
- Cash Discount Price: $8,125
- vs. Medicare Baseline: 1.28x Medicare
The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Palmetto General Hospital is $137. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,125. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.28x the Medicare baseline. Located in 2001 W 68Th St, Hialeah, FL.
Cash / Self-Pay
$8,125
Average discount available for prompt cash payment at this facility.
Insurance Median
$137
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: $8,125 (7607%)
Insurance Median: $137 (128%)
Cash: $8,125 (7607% of Medicare)
Ins. Median: $137 (128% 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.
Out-of-Pocket Cost Estimator
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Humana | $68 - $206 | 64% |
| Medicaid / KanCare | $68 - $8,125 | 64% |
| UnitedHealthcare | $69 - $103 | 65% |
| Veterans Administration Mill Bill | $72 | 67% |
| Medicare (plans) | $93 - $8,125 | 87% |
| Aetna | $103 - $5,769 | 96% |
| Devoted Health | $103 | 96% |
| Leon Health Inc | $103 | 96% |
| Tricare | $104 | 97% |
| Bristol Hospice- Miami Dade Llc | $105 | 98% |
| Catholic Hospice | $105 | 98% |
| Compassionate Care Hospice Of Miami Dade And The Fl Keys Inc | $105 | 98% |
| Employer Direct Healthcare | $105 - $165 | 98% |
| Hospice Other | $105 | 98% |
| Ima Evalutations Inc | $105 | 98% |
| Odyssey Healthcare Of Marion County Dba Kindred Hospice | $105 | 98% |
| Opuscare Of South Fl | $105 | 98% |
| Seasons Hospice And Pallative Care Of Southern Florida Inc | $105 | 98% |
| Select Specialty Hospital | $105 | 98% |
| Veterans Administration Vaccn | $105 | 98% |
| Vitas Healthcare Hospice | $105 | 98% |
| Westchester General Hospital | $105 | 98% |
| Cigna | $108 - $4,063 | 101% |
| Healthsun Health Plans | $108 - $137 | 101% |
| Longevity Health Plan | $110 | 103% |
| Avmed Broad Network | $113 | 106% |
| Florida Pace Centers | $124 | 116% |
| Bright Health Management Commercial | $126 | 118% |
| Self Pay/Uninsured | $129 - $163 | 121% |
| Naphcare Inc | $144 | 135% |
| Imagine Health | $145 | 136% |
| Dimension Health Wc | $146 | 137% |
| Workers Compensation | $146 | 137% |
| Avmed Exchange | $183 | 171% |
| Oscar Health Plan Hix | $189 | 177% |
| Ambetter / Centene | $194 | 182% |
| Molina Marketplace Program Exchange | $199 | 186% |
| Auto Insurance | $209 | 196% |
| Avmed Select Network | $214 | 200% |
| Amerihealth Caritas Next Exchange | $225 | 211% |
| Bc/Bs Of Fl Miami Dade Blue Select | $258 | 242% |
| Bc/Bs Of Fl Health Options Hmo | $327 | 306% |
| Bc/Bs Of Fl Network Blue | $330 | 309% |
| Bc/Bs Myblue Hmo Hix | $337 | 316% |
| Bc/Bs Of Fl Simplyblue | $354 | 331% |
| Bc/Bs Of Fl Blue Select Exchange Non Par | $364 | 341% |
| Bc/Bs Of Fl Ppo | $387 | 362% |
| Liga Contra El Cancer | $2,000 | 1872% |
| Bc/Bs Of Fl Phs | $4,076 | 3816% |
| Magellan Behavioral Health | $4,875 | 4564% |
| Dimensions International | $5,281 | 4944% |
| First Health | $5,444 | 5097% |
| Dimension Health Ppo | $6,094 | 5705% |
| Beacon Health Strategies Commercial | $8,125 | 7607% |
| Commercial Non-Contracted | $8,125 | 7607% |
| Self Pay - Mcd Pending 100 Percent | $8,125 | 7607% |
| Single Case Agreement | $8,125 | 7607% |
| United Behavioral Health Psych | $8,125 | 7607% |