CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: HCA Florida South Shore Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $2,805
Cash Discount Price: $17,106
vs. Medicare Baseline: 26.26x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at HCA Florida South Shore Hospital is $2,805. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $17,106. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 26.26x the Medicare baseline. Located in 4016 Sun City Center Blvd, Sun City Center, FL.

Cash / Self-Pay

$17,106

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,805

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: $17,106 (16015%)

Insurance Median: $2,805 (2626%)

Cash: $17,106 (16015% of Medicare)

Ins. Median: $2,805 (2626% 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 2626% of the Medicare baseline (a markup of 2526%). 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 - $7,863	229%
Avmed	$738 - $1,863	691%
Access 2 Healthcare Physicians Freedom Optimum Group Members	$787 - $821	737%
Aetna	$913 - $5,242	855%
Access 2 Healthcare Physicians Freedom Health	$1,205 - $1,258	1128%
Access 2 Healthcare Physicians Optimum	$1,205 - $1,258	1128%
Freedom Health Care	$1,306 - $1,363	1223%
Optimum Healthcare	$1,306 - $1,363	1223%
Corvel Corporation	$2,345	2195%
Rockport Healthcare Group	$2,345	2195%
Prime Health	$2,394	2241%
Simply Healthcare	$2,578 - $2,691	2414%
Molina	$3,180 - $4,718	2977%
Sunshine State Health Plan	$4,268 - $4,456	3996%
Plotkin Health	$8,369 - $8,737	7835%
Prime Health Sheriff	$8,369 - $8,737	7835%
Evolutions Healthcare Systems	$9,206 - $16,076	8619%
Multiplan	$12,554 - $14,853	11754%

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 $17,106.
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 South Shore 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.