CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: HCA Florida Orange Park Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $4,691
Cash Discount Price: $15,633
vs. Medicare Baseline: 43.92x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at HCA Florida Orange Park Hospital is $4,691. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $15,633. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 43.92x the Medicare baseline. Located in 2001 Kingsley Ave, Orange Park, FL.

Cash / Self-Pay

$15,633

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,691

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: $15,633 (14636%)

Insurance Median: $4,691 (4392%)

Cash: $15,633 (14636% of Medicare)

Ins. Median: $4,691 (4392% 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 4392% of the Medicare baseline (a markup of 4292%). 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 - $7,037	229%
Aetna	$716 - $4,691	670%
Avmed	$825 - $1,863	772%
Optimum Healthcare	$1,313 - $1,314	1229%
Corvel Corporation	$2,310	2163%
Prime Health	$2,359	2209%
Simply Healthcare	$2,407 - $2,408	2254%
Positive Healthcare	$3,438 - $3,440	3219%
Sunshine State Health Plan	$3,985 - $3,987	3731%
Molina Healthcare	$4,220 - $4,222	3951%
Medicare (plans)	$7,033 - $7,037	6585%
Plotkin Health	$7,814 - $7,819	7316%
Multiplan	$12,190 - $13,292	11413%
Evernorth	$12,503 - $12,510	11706%
Evolutions Healthcare	$12,503 - $13,292	11706%
Ppo Next	$13,284 - $13,292	12437%
Novanet	$14,065 - $14,073	13168%

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 $15,633.
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 Orange Park 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.