CMS Price Transparency Data

CT scan, neck (cervical spine)

Facility: Lexington Memorial Hospital Inc

Billing Code: 72125 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72125
Insurance Median: $1,255
Cash Discount Price: $1,410
vs. Medicare Baseline: 11.75x Medicare

The contracted insurance negotiated median rate for a CT scan, neck (cervical spine) at Lexington Memorial Hospital Inc is $1,255. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,410. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 11.75x the Medicare baseline. Located in 250 Hospital Drive Po Box 1817, Lexington, NC.

Cash / Self-Pay

$1,410

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,255

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: $1,410 (1320%)

Insurance Median: $1,255 (1175%)

Cash: $1,410 (1320% of Medicare)

Ins. Median: $1,255 (1175% 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 1175% of the Medicare baseline (a markup of 1075%). 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	$531 - $775	497%
Carolina Complete	$531	497%
Healthy Blue	$531	497%
Partners	$531	497%
UnitedHealthcare	$536 - $1,263	502%
Vaya	$536	502%
Wellcare	$536	502%
Alliance	$542	507%
Trillium	$547	512%
Medcost	$617 - $1,886	578%
Blue Cross Blue Shield	$786 - $1,262	736%
Aetna	$801 - $2,605	750%
Ambetter / Centene	$809	757%
Oscar	$902 - $1,240	844%
Cigna	$1,226 - $1,249	1148%
Directnet	$1,666	1560%
Healthgram Lexington Home Brands	$2,030	1901%
Healthgram	$2,255	2111%
Private Healthcare Systems	$2,312	2165%
Beechstreet	$2,481	2323%
Humana	$2,481	2323%
Multiplan	$2,537	2375%
National Provider Network	$2,537	2375%

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 $1,410.
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 Lexington Memorial Hospital Inc 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.