CMS Price Transparency Data

CT scan, pelvis

Facility: Lexington Memorial Hospital Inc

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $627
Cash Discount Price: $704
vs. Medicare Baseline: 5.87x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Lexington Memorial Hospital Inc is $627. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $704. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.87x the Medicare baseline. Located in 250 Hospital Drive Po Box 1817, Lexington, NC.

Cash / Self-Pay

$704

Average discount available for prompt cash payment at this facility.

Insurance Median

$627

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: $704 (659%)

Insurance Median: $627 (587%)

Cash: $704 (659% of Medicare)

Ins. Median: $627 (587% 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 587% of the Medicare baseline (a markup of 487%). 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	$265 - $387	248%
Carolina Complete	$265	248%
Healthy Blue	$265	248%
Partners	$265	248%
UnitedHealthcare	$268 - $630	251%
Vaya	$268	251%
Wellcare	$268	251%
Alliance	$270	253%
Trillium	$273	256%
Medcost	$308 - $941	288%
Blue Cross Blue Shield	$393 - $630	368%
Aetna	$400 - $1,300	374%
Ambetter / Centene	$404	378%
Oscar	$450 - $619	421%
Cigna	$612 - $623	573%
Directnet	$832	779%
Healthgram Lexington Home Brands	$1,013	948%
Healthgram	$1,126	1054%
Private Healthcare Systems	$1,154	1080%
Beechstreet	$1,238	1159%
Humana	$1,238	1159%
Multiplan	$1,266	1185%
National Provider Network	$1,266	1185%

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 $704.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72192.

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 72192.
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.