CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: HCA Florida Fawcett Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $2,320
Cash Discount Price: $18,042
vs. Medicare Baseline: 21.72x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at HCA Florida Fawcett Hospital is $2,320. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $18,042. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 21.72x the Medicare baseline. Located in 21298 Olean Blvd, Port Charlotte, FL.

Cash / Self-Pay

$18,042

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,320

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: $18,042 (16892%)

Insurance Median: $2,320 (2172%)

Cash: $18,042 (16892% of Medicare)

Ins. Median: $2,320 (2172% 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 2172% of the Medicare baseline (a markup of 2072%). 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 - $8,119	229%
Avmed	$738 - $1,863	691%
Access 2 Healthcare Physicians Freedom Optimum Group Members	$848	794%
Aetna	$848 - $5,413	794%
Access 2 Healthcare Physicians Freedom Health	$1,299	1216%
Access 2 Healthcare Physicians Optimum	$1,299	1216%
Freedom Health Care	$1,407	1317%
Optimum Healthcare	$1,407	1317%
Corvel Corporation	$2,272	2127%
Rockport Healthcare Group	$2,272	2127%
Prime Health	$2,320	2172%
Simply Healthcare	$2,779	2602%
Molina	$3,428 - $4,871	3209%
Sunshine State Health Plan	$4,601	4308%
Behealthy America	$7,036	6587%
Evolutions Healthcare Systems	$9,021 - $16,599	8446%
Plotkin Health	$9,021	8446%
Prime Health Sheriff	$9,021	8446%
Multiplan	$13,532 - $15,336	12669%

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 $18,042.
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 Fawcett 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.