CMS Price Transparency Data

CT scan, neck (cervical spine)

Facility: Hamilton Memorial Hospital

Billing Code: 72125 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72125
Insurance Median: $1,358
Cash Discount Price: $1,574
vs. Medicare Baseline: 12.71x Medicare

The contracted insurance negotiated median rate for a CT scan, neck (cervical spine) at Hamilton Memorial Hospital is $1,358. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,574. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 12.71x the Medicare baseline. Located in 611 S Marshall Avenue, McLeansboro, IL.

Cash / Self-Pay

$1,574

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,358

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: $1,574 (1474%)

Insurance Median: $1,358 (1271%)

Cash: $1,574 (1474% of Medicare)

Ins. Median: $1,358 (1271% 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 1271% of the Medicare baseline (a markup of 1171%). 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
Aetna	$124 - $1,667	116%
Blue Cross Blue Shield	$124 - $1,686	116%
Health Alliance	$124 - $1,482	116%
Medicare (plans)	$124 - $741	116%
UnitedHealthcare	$124 - $1,326	116%
Wellcare	$124 - $741	116%
Medicaid / KanCare	$689 - $741	645%
Alliance Coal	$741	694%
Humana	$741	694%
Healthlink	$787 - $910	737%
Healthscope	$1,297	1214%
Wellfirst (Ssmhic)	$1,297	1214%
Hope Trust	$1,389	1300%
Cigna	$1,454	1361%
Hfn, Inc	$1,482 - $1,667	1388%
Multiplan	$1,574	1474%
Siho	$1,667	1561%
Three Rivers Provider	$1,667	1561%
Healthsmart	$1,760	1648%
Stratose	$1,760	1648%

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 $1,574.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72125.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Hamilton Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72125.
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.