CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: HCA Florida Fort Walton-Destin Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $8,368
Cash Discount Price: $16,736
vs. Medicare Baseline: 78.34x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at HCA Florida Fort Walton-Destin Hospital is $8,368. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $16,736. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 78.34x the Medicare baseline. Located in 1000 Mar-Walt Dr, Fort Walton Beach, FL.

Cash / Self-Pay

$16,736

Average discount available for prompt cash payment at this facility.

Insurance Median

$8,368

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: $16,736 (15669%)

Insurance Median: $8,368 (7834%)

Cash: $16,736 (15669% of Medicare)

Ins. Median: $8,368 (7834% 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 7834% of the Medicare baseline (a markup of 7734%). 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 - $7,659	229%
Avmed	$1,695 - $8,510	1587%
Aetna	$1,696 - $5,106	1588%
Corvel Corporation	$2,335	2186%
Simply	$2,383 - $2,621	2231%
Prime Health	$2,384	2232%
Careworks (Rockport Community)	$2,458	2301%
Molina Healthcare	$2,940 - $5,446	2753%
Sunshine State Health Plan	$3,945 - $4,340	3693%
Plotkin Health	$7,736 - $8,510	7243%
Prime Health Sheriff	$7,736 - $8,510	7243%
Evolutions Healthcare	$10,057 - $15,318	9416%
Naphcare	$10,057 - $11,063	9416%
Multiplan	$12,068 - $14,467	11299%
Evernorth	$12,377 - $13,616	11588%
Ppo Next	$13,151 - $14,467	12313%
Novanet	$13,925 - $15,318	13037%
Beacon Health Options	$15,472 - $17,020	14486%

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 $16,736.
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 Fort Walton-Destin 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.