CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: HCA Florida Raulerson Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $2,401
Cash Discount Price: $8,425
vs. Medicare Baseline: 22.48x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at HCA Florida Raulerson Hospital is $2,401. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,425. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 22.48x the Medicare baseline. Located in 1796 Hwy 441 North, Okeechobee, FL.

Cash / Self-Pay

$8,425

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,401

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: $8,425 (7888%)

Insurance Median: $2,401 (2248%)

Cash: $8,425 (7888% of Medicare)

Ins. Median: $2,401 (2248% 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 2248% of the Medicare baseline (a markup of 2148%). 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 - $3,791	229%
Freedom Health	$725	679%
Optimum	$725	679%
Avmed	$890 - $4,212	833%
Aetna	$1,087 - $2,528	1018%
Simply Healthcare Plans	$1,095	1025%
Molina	$1,601 - $2,275	1499%
Health Sun Health Plan	$1,795	1681%
Sunshine State Health Plan	$2,148	2011%
Corvel Corporation	$2,174	2035%
Careworks (Rockport)	$2,220	2078%
Prime Health	$2,220	2078%
United Ppo	$3,707	3471%
Plotkin Health	$4,212	3943%
Prime Health Sherriff	$4,212	3943%
Multiplan	$6,319 - $7,161	5916%

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 $8,425.
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 Raulerson 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.