CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: St Josephs Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $2,142
Cash Discount Price: $3,241
vs. Medicare Baseline: 20.05x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at St Josephs Hospital is $2,142. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,241. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 20.05x the Medicare baseline. Located in 3001 W Martin Luther King Jr Blvd, Tampa, FL.

Cash / Self-Pay

$3,241

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,142

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: $3,241 (3034%)

Insurance Median: $2,142 (2005%)

Cash: $3,241 (3034% of Medicare)

Ins. Median: $2,142 (2005% 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 2005% of the Medicare baseline (a markup of 1905%). 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
Clear Health Alliance	$68	64%
UnitedHealthcare	$69 - $4,862	65%
Humana	$70 - $133	66%
Freedom Health	$71	66%
Molina Healthcare	$71	66%
Simply Healthcare	$71 - $972	66%
Sunshine Health	$71	66%
Aetna	$72 - $4,403	67%
Florida Community Care	$74	69%
Baycareplus	$107	100%
Blue Cross Blue Shield	$107 - $2,859	100%
Solis Health	$117	110%
Cigna	$123 - $4,700	115%
Wellcare	$149	140%
Ambetter / Centene	$240 - $5,402	225%
Molina	$972 - $3,193	910%
Freedom	$1,080	1011%
Optimum	$1,080	1011%
Careplus	$1,234	1155%
Ultimate Health Plan	$1,621	1518%
Avmed	$1,675 - $2,647	1568%
Evolutions	$2,701 - $5,024	2529%
First Health	$4,592	4299%
Multiplan	$4,862	4552%
United Behavioral Health	$5,402	5058%

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 $3,241.
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 St Josephs 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.