CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Jersey Shore University Medical Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $541
Cash Discount Price: $118
vs. Medicare Baseline: 5.07x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Jersey Shore University Medical Center is $541. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $118. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.07x the Medicare baseline. Located in 1945 Rte 33, Neptune, NJ.

Cash / Self-Pay

$118

Average discount available for prompt cash payment at this facility.

Insurance Median

$541

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: $118 (110%)

Insurance Median: $541 (507%)

Cash: $118 (110% of Medicare)

Ins. Median: $541 (507% 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 507% of the Medicare baseline (a markup of 407%). 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
Karna	$83 - $242	78%
Blue Cross Blue Shield	$118	110%
UnitedHealthcare	$118 - $714	110%
Vaccn	$118	110%
Wellcare	$118	110%
United Community/Americhoice	$124	116%
Aetna	$128 - $1,809	120%
Cigna	$256 - $1,848	240%
Oxford	$335	314%
Clover	$416	389%
Seoul Medical Group	$534	500%
Amerihealth	$541 - $551	507%
Activecare First McO	$650	609%
Brighton Health Plan	$1,594	1492%
Horizon	$1,669 - $2,310	1563%
Beacon	$1,732	1622%
Bergen Risk	$1,732	1622%
Multiplan - PHCS	$1,964	1839%
Qualcare	$2,083 - $2,218	1950%

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 $118.
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 Jersey Shore University Medical Center 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.