CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: HCA Florida Capital Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $3,651
Cash Discount Price: $7,780
vs. Medicare Baseline: 34.18x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at HCA Florida Capital Hospital is $3,651. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,780. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 34.18x the Medicare baseline. Located in 2626 Capital Medical Blvd, Tallahassee, FL.

Cash / Self-Pay

$7,780

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,651

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: $7,780 (7284%)

Insurance Median: $3,651 (3418%)

Cash: $7,780 (7284% of Medicare)

Ins. Median: $3,651 (3418% 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 3418% of the Medicare baseline (a markup of 3318%). 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 - $3,717	229%
Simply	$1,124 - $1,272	1052%
Aetna	$1,258 - $2,478	1178%
Molina Healthcare	$1,387 - $2,643	1299%
Avmed	$1,695 - $4,130	1587%
Sunshine State Health Plan	$1,862 - $2,106	1743%
Corvel Corporation	$2,149	2012%
Prime Health	$2,194	2054%
Careworks (Rockport Community)	$2,262	2118%
Plotkin Health	$3,651 - $4,130	3418%
Prime Health Sheriff	$3,651 - $4,130	3418%
Multiplan	$5,695 - $7,020	5332%
Evernorth	$5,841 - $6,607	5469%
Evolutions Healthcare	$6,206 - $7,020	5810%
Ppo Next	$6,206 - $7,020	5810%
Novanet	$6,571 - $7,433	6152%
Beacon Health Options	$7,301 - $8,259	6836%

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 $7,780.
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 Capital 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.