CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Sarasota Memorial Hospital - Venice

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $2,558
Cash Discount Price: $2,133
vs. Medicare Baseline: 23.95x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Sarasota Memorial Hospital - Venice is $2,558. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,133. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 23.95x the Medicare baseline. Located in 2600 Laurel Road East, North Venice, FL.

Cash / Self-Pay

$2,133

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,558

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: $2,133 (1997%)

Insurance Median: $2,558 (2395%)

Cash: $2,133 (1997% of Medicare)

Ins. Median: $2,558 (2395% 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 2395% of the Medicare baseline (a markup of 2295%). 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
Simply Healthcare	$67 - $71	63%
Sunshine State	$71	66%
Molina	$73	68%
Amerihealth Caritas	$74	69%
Community Care Plan	$74	69%
Florida Community Care	$74 - $117	69%
Blue Cross Blue Shield	$107	100%
Aetna	$110 - $4,875	103%
UnitedHealthcare	$110 - $4,577	103%
Simply Freedom Optimum	$112	105%
Wellcare	$112	105%
Ambetter / Centene	$288	270%
Careworks	$2,558 - $3,413	2395%
Enlyte	$2,558 - $3,413	2395%
Avmed	$3,337 - $4,449	3124%
Usa Managed Care	$3,657 - $4,875	3424%
First Health	$3,794 - $5,058	3552%

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 $2,133.
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 Sarasota Memorial Hospital - Venice 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.