CMS Price Transparency Data

CT scan, neck (cervical spine)

Facility: Highland Hospital

Billing Code: 72125 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72125
Insurance Median: $191
Cash Discount Price: $794
vs. Medicare Baseline: 1.79x Medicare

The contracted insurance negotiated median rate for a CT scan, neck (cervical spine) at Highland Hospital is $191. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $794. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.79x the Medicare baseline. Located in 1000 South Avenue, Rochester, NY.

Cash / Self-Pay

$794

Average discount available for prompt cash payment at this facility.

Insurance Median

$191

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: $794 (743%)

Insurance Median: $191 (179%)

Cash: $794 (743% of Medicare)

Ins. Median: $191 (179% 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.

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
Medicare (plans)	$106 - $174	99%
Medicaid / KanCare	$107 - $438	100%
Aetna	$123 - $393	115%
Elderplan [1316]	$123	115%
Excellus Bc/Bs [2201]	$123 - $231	115%
Icircle [1728]	$123	115%
Martins Point [1205]	$123 - $130	115%
Nascentia [1729]	$123	115%
UnitedHealthcare	$123 - $371	115%
Humana	$124 - $161	116%
Blue Cross Blue Shield	$130 - $186	122%
Amerigroup (Bswny Alternate) [1720]	$141	132%
Excellus [2201]	$141 - $244	132%
Molina Healthcare [5189], Molina Healthcare [1723]	$141	132%
Highmark Bc/Bs Of Western Ny [5143]	$155 - $161	145%
Mvp [2900]	$160 - $610	150%
Excellus Bc/Bs [2201], Bc/Bs Out Of Area [2401]	$197 - $431	184%
Cigna	$222 - $610	208%
Independent Health [5156]	$287 - $348	269%
Fidelis [5155]	$311 - $460	291%
Capital District Physicians Health Plan (Cdphp) [5149]	$330 - $441	309%

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 $794.
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 Highland 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.