CMS Price Transparency Data

CT scan, head (with contrast)

Facility: Lexington Memorial Hospital Inc

Billing Code: 70460 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70460
Insurance Median: $1,461
Cash Discount Price: $1,641
vs. Medicare Baseline: 8.15x Medicare

The contracted insurance negotiated median rate for a CT scan, head (with contrast) at Lexington Memorial Hospital Inc is $1,461. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,641. Compared to the federal Medicare reimbursement reference rate of $179.2, this hospital’s rate is 8.15x the Medicare baseline. Located in 250 Hospital Drive Po Box 1817, Lexington, NC.

Cash / Self-Pay

$1,641

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,461

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$179.2

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $179.2 (100%)

Cash / Self-Pay: $1,641 (916%)

Insurance Median: $1,461 (815%)

Cash: $1,641 (916% of Medicare)

Ins. Median: $1,461 (815% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $179.2 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 815% of the Medicare baseline (a markup of 715%). 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
Amerihealth	$618 - $902	345%
Carolina Complete	$618	345%
Healthy Blue	$618	345%
Partners	$618	345%
UnitedHealthcare	$624 - $1,470	348%
Vaya	$624	348%
Wellcare	$624	348%
Alliance	$631	352%
Trillium	$637	355%
Medcost	$719 - $2,195	401%
Blue Cross Blue Shield	$915 - $1,469	511%
Aetna	$932 - $3,032	520%
Ambetter / Centene	$942	526%
Oscar	$1,050 - $1,444	586%
Cigna	$1,427 - $1,453	796%
Directnet	$1,939	1082%
Healthgram Lexington Home Brands	$2,362	1318%
Healthgram	$2,625	1465%
Private Healthcare Systems	$2,690	1501%
Beechstreet	$2,887	1611%
Humana	$2,887	1611%
Multiplan	$2,953	1648%
National Provider Network	$2,953	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 $1,641.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70460.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Lexington Memorial Hospital Inc is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 70460.
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.