CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: HCA Florida Englewood Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $2,395
Cash Discount Price: $19,797
vs. Medicare Baseline: 22.42x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at HCA Florida Englewood Hospital is $2,395. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $19,797. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 22.42x the Medicare baseline. Located in 700 Medical Blvd, Englewood, FL.

Cash / Self-Pay

$19,797

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,395

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: $19,797 (18535%)

Insurance Median: $2,395 (2242%)

Cash: $19,797 (18535% of Medicare)

Ins. Median: $2,395 (2242% 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 2242% of the Medicare baseline (a markup of 2142%). 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 - $8,909	229%
Avmed	$738 - $1,863	691%
Aetna	$848 - $5,939	794%
Access 2 Healthcare Physicians Freedom Optimum Group Members	$930	871%
Access 2 Healthcare Physicians Freedom Health	$1,425	1334%
Access 2 Healthcare Physicians Optimum	$1,425	1334%
Freedom Health Care	$1,544	1446%
Optimum Healthcare	$1,544	1446%
Corvel Corporation	$2,345	2195%
Rockport Healthcare Group	$2,345	2195%
Prime Health	$2,394	2241%
Simply Healthcare	$3,049	2855%
Molina	$3,762 - $5,345	3522%
Sunshine State Health Plan	$5,048	4726%
Behealthy America	$7,721	7229%
Evolutions Healthcare Systems	$9,899 - $18,214	9268%
Plotkin Health	$9,899	9268%
Prime Health Sheriff	$9,899	9268%
Multiplan	$14,848 - $16,828	13901%

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 $19,797.
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 Englewood 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.