CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: St Joseph's University Medical Center Inc

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72131
  • Insurance Median: $147
  • Cash Discount Price: $2,335
  • vs. Medicare Baseline: 1.38x Medicare
The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at St Joseph's University Medical Center Inc is $147. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,335. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.38x the Medicare baseline. Located in 703 Main St, Paterson, NJ.
Cash / Self-Pay
$2,335

Average discount available for prompt cash payment at this facility.

Insurance Median
$147

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: $2,335 (2186%)
Insurance Median: $147 (138%)
Cash: $2,335 (2186% of Medicare)
Ins. Median: $147 (138% 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.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Fidelis Care of New Jersey $38 - $467 36%
UnitedHealthcare $38 - $415 36%
Aetna $50 - $480 47%
Ambetter / Centene $50 - $186 47%
Amerihealth $50 - $1,487 47%
Clover Health $50 - $147 47%
Horizon New Jersey Total Care $50 - $147 47%
Wellpoint $50 - $459 47%
Blue Cross Blue Shield $56 - $466 52%
Multiplan $76 - $1,751 71%
Longevity Health Plan $143 134%
Oxford $160 150%
Horizon New Jersey Health $238 223%
Consumer Health Network $386 - $2,102 361%
Private Healthcare Systems $1,518 1421%
Magnacare $1,634 1530%
Oscar $2,200 2060%
Cigna $2,335 2186%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 703 Main St, Paterson, NJ 07503
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals