CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: HCA Florida Kendall Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $4,075
Cash Discount Price: $16,399
vs. Medicare Baseline: 38.15x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at HCA Florida Kendall Hospital is $4,075. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $16,399. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 38.15x the Medicare baseline. Located in 11750 Bird Rd, Miami, FL.

Cash / Self-Pay

$16,399

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,075

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: $16,399 (15353%)

Insurance Median: $4,075 (3815%)

Cash: $16,399 (15353% of Medicare)

Ins. Median: $4,075 (3815% 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 3815% of the Medicare baseline (a markup of 3715%). 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 - $7,380	229%
Aetna	$809 - $4,920	757%
Avmed	$845 - $8,200	791%
Freedom Health	$1,410 - $2,624	1320%
Optimum	$1,410	1320%
Simply Healthcare Plans	$2,132	1996%
Corvel Corporation	$2,519	2358%
Careworks (Rockport)	$2,572	2408%
Prime Health	$2,572	2408%
Molina	$3,116 - $4,428	2917%
Health Sun Health Plan	$3,493	3270%
Aids Healthcare	$3,608 - $19,679	3378%
Mmm Of Fl (Health Advantage Plan)	$3,772	3532%
United Ppo	$3,887	3639%
Sunshine State Health Plan	$4,264	3992%
Plotkin Health	$8,200	7677%
Prime Health Sherriff	$8,200	7677%
Medica Healthcare	$9,511	8905%
Multiplan	$12,299 - $13,939	11515%
Evernorth Bh	$13,119	12283%

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 $16,399.
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 Kendall 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.