CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Jfk University Medical Center

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $451
Cash Discount Price: $112
vs. Medicare Baseline: 4.22x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Jfk University Medical Center is $451. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $112. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.22x the Medicare baseline. Located in 65 James Street, Edison, NJ.

Cash / Self-Pay

$112

Average discount available for prompt cash payment at this facility.

Insurance Median

$451

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: $112 (105%)

Insurance Median: $451 (422%)

Cash: $112 (105% of Medicare)

Ins. Median: $451 (422% 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 422% of the Medicare baseline (a markup of 322%). 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	$86 - $254	81%
Vaccn	$106 - $118	99%
Amerigroup	$106 - $118	99%
Horizon	$106 - $2,147	99%
Wellcare	$106 - $118	99%
Aetna	$106 - $1,940	99%
United Community/Americhoice	$112 - $124	105%
Blue Cross Blue Shield	$118	110%
Cigna	$263	246%
UnitedHealthcare	$281 - $397	263%
Oxford	$281	263%
Clover	$416	389%
Amerihealth	$493 - $545	462%
Seoul Medical Group	$497	465%
Brighton Health Plan	$1,594	1492%
Intergroup	$1,617	1514%
Activecare First McO	$1,617	1514%
Bergen Risk	$1,732	1622%
Qualcare	$1,786 - $1,871	1672%
Prime Health	$1,848	1730%
Multiplan - PHCS	$1,964	1839%

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 $112.
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 Jfk 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.