CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: St Jude Childrens Research Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $259
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.42x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at St Jude Childrens Research Hospital is $259. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.42x the Medicare baseline. Located in 262 Danny Thomas Place, Memphis, TN.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$259

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%)

Insurance Median: $259 (242%)

Ins. Median: $259 (242% 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 242% of the Medicare baseline (a markup of 142%). 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
Oklahoma Complete Health	$51	48%
UnitedHealthcare	$56 - $1,294	52%
Home State Health	$89	83%
Medicaid / KanCare	$97	91%
Molina Marketplace Of Ms	$140	131%
Blue Cross Blue Shield	$179 - $245	168%
Tenncare Select Hmo	$196	184%
Health Choice - Ok	$213	199%
Empower	$215	201%
Healthcare Connections La	$274	257%
Healthy Blue	$449	420%
Cigna	$550	515%
Humana	$680	637%
Vantage	$1,078 - $1,204	1009%
Aetna	$1,348	1262%
Private Health Care Systems	$1,438	1346%
Ms Physicians Care Network	$1,527	1430%
Baptist Health	$1,617	1514%
First Health Ccn	$1,617	1514%
Health Choice	$1,617	1514%
Health Link Mississippi	$1,617	1514%
Healthscope Benefits Inc	$1,617	1514%
Tricare	$1,797	1682%

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 $X.
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 Jude Childrens Research 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.