CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: HCA Florida West Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $3,582
Cash Discount Price: $11,556
vs. Medicare Baseline: 33.54x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at HCA Florida West Hospital is $3,582. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $11,556. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 33.54x the Medicare baseline. Located in 8383 N Davis Hwy, Pensacola, FL.

Cash / Self-Pay

$11,556

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,582

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: $11,556 (10819%)

Insurance Median: $3,582 (3354%)

Cash: $11,556 (10819% of Medicare)

Ins. Median: $3,582 (3354% 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 3354% of the Medicare baseline (a markup of 3254%). 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 - $5,200	229%
Aetna	$1,258 - $3,467	1178%
Freedom Health	$1,468	1374%
Avmed	$1,695 - $5,778	1587%
Simply	$1,780	1667%
Molina Healthcare	$2,196 - $3,698	2056%
Corvel Corporation	$2,221	2079%
Prime Health	$2,267	2122%
Careworks (Rockport Community)	$2,337	2188%
Sunshine State Health Plan	$2,947	2759%
Plotkin Health	$5,778	5410%
Prime Health Sheriff	$5,778	5410%
Evolutions Healthcare	$7,511 - $9,822	7032%
Multiplan	$9,013 - $9,822	8438%
Evernorth	$9,245	8656%
Ppo Next	$9,822	9196%
Novanet	$10,400	9737%
Beacon Health Options	$11,556	10819%

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 $11,556.
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 West 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.