CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Nemours Childrens Hospital, Florida

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,790
Cash Discount Price: $4,475
vs. Medicare Baseline: 16.76x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Nemours Childrens Hospital, Florida is $1,790. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,475. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 16.76x the Medicare baseline. Located in 6535 Nemours Pkwy, Orlando, FL.

Cash / Self-Pay

$4,475

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,790

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: $4,475 (4190%)

Insurance Median: $1,790 (1676%)

Cash: $4,475 (4190% of Medicare)

Ins. Median: $1,790 (1676% 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 1676% of the Medicare baseline (a markup of 1576%). 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
Tricare	$107	100%
Aetna	$630	590%
Truli	$729 - $1,790	683%
Avmed	$795	744%
Florida Blue	$810 - $2,730	758%
Evolutions Healthcare	$927	868%
UnitedHealthcare	$1,426	1335%
Cigna	$1,443	1351%
Employers Health Network Fl	$1,790	1676%
Integra Administrative Group	$2,685	2514%
Global Medical Management	$2,909	2724%
Prime Health Services	$2,909	2724%
Star Healthcare Network	$2,909	2724%
Velocity	$3,356	3142%
First Health Network	$3,490	3267%
Pnoa	$3,580	3352%
Seminole Tribe Of Fl	$3,580	3352%
Private Healthcare Systems	$4,117	3855%

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 $4,475.
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 Nemours Childrens Hospital, Florida 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.