CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Gulf Breeze Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $872
Cash Discount Price: $1,200
vs. Medicare Baseline: 8.16x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Gulf Breeze Hospital is $872. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,200. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 8.16x the Medicare baseline. Located in 1110 Gulf Breeze Pkwy, Gulf Breeze, FL.

Cash / Self-Pay

$1,200

Average discount available for prompt cash payment at this facility.

Insurance Median

$872

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: $1,200 (1123%)

Insurance Median: $872 (816%)

Cash: $1,200 (1123% of Medicare)

Ins. Median: $872 (816% 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 816% of the Medicare baseline (a markup of 716%). 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
Aetna	$68 - $5,840	64%
Cha Health Plan	$68	64%
UnitedHealthcare	$68 - $1,900	64%
Humana	$72 - $109	67%
Sunshine Health	$72	67%
Wellcare	$72 - $112	67%
Fl Community Care Ltc	$73	68%
Simply Healthcare Healthy Kids	$79	74%
Medicare (plans)	$100	94%
Hospice Covenant	$107	100%
Fl Blue	$178 - $1,676	167%
Uwf Athletes	$330	309%
Bc Fl	$1,043	977%
Pensacola	$1,200	1123%
Wc Corvel	$2,079 - $7,600	1946%
Hospice Regency	$2,400	2247%
Cigna	$3,800 - $8,000	3558%
Hospice Emerald Coast	$4,000	3745%
Private Healthcare	$5,200	4868%
First Health	$5,560	5206%
Choicecare	$6,000	5617%
Multiplan	$7,120	6666%

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 $1,200.
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 Gulf Breeze 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.