CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Fishermen's Community Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $2,858
Cash Discount Price: $3,283
vs. Medicare Baseline: 26.76x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Fishermen's Community Hospital is $2,858. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,283. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 26.76x the Medicare baseline. Located in 3301 Overseas Hwy, Marathon, FL.

Cash / Self-Pay

$3,283

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,858

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: $3,283 (3074%)

Insurance Median: $2,858 (2676%)

Cash: $3,283 (3074% of Medicare)

Ins. Median: $2,858 (2676% 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 2676% of the Medicare baseline (a markup of 2576%). 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
Amerigroup	$65	61%
Medicaid / KanCare	$65 - $72	61%
UnitedHealthcare	$65 - $5,050	61%
Sunshine State	$69	65%
Wellcare	$69	65%
Aetna	$71 - $3,868	66%
Vista	$71	66%
Blue Cross Blue Shield	$843 - $5,050	789%
Leon Medical	$1,060	992%
Medica Health Plan	$1,060	992%
Medicare (plans)	$1,060 - $1,432	992%
Humana	$1,156	1082%
Avmed	$1,167 - $4,181	1093%
Cigna	$1,209 - $4,040	1132%
Non Contracted	$1,853	1735%
International	$3,282	3073%
Amerihealth	$3,788	3546%
Dimension Health Plan	$3,788 - $4,545	3546%
Affordable	$4,545	4255%
Phcs	$4,545	4255%
Quality Health	$4,545	4255%

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 $3,283.
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 Fishermen's Community 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.