CMS Price Transparency Data

CT scan, neck (cervical spine)

Facility: UPMC Presbyterian Shadyside

Billing Code: 72125 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72125
Insurance Median: $2,295
Cash Discount Price: $2,937
vs. Medicare Baseline: 21.49x Medicare

The contracted insurance negotiated median rate for a CT scan, neck (cervical spine) at UPMC Presbyterian Shadyside is $2,295. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,937. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 21.49x the Medicare baseline. Located in 200 Lothrop Street, Pittsburgh, PA.

Cash / Self-Pay

$2,937

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,295

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: $2,937 (2750%)

Insurance Median: $2,295 (2149%)

Cash: $2,937 (2750% of Medicare)

Ins. Median: $2,295 (2149% 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 2149% of the Medicare baseline (a markup of 2049%). 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
UnitedHealthcare	$100 - $109	94%
Amerihealth Caritas	$109 - $211	102%
Cigna	$109	102%
Highmark Wholecare (Prev Gateway)	$109 - $2,448	102%
Pa Health & Wellness	$109 - $228	102%
Aetna	$112 - $1,224	105%
Upmc Health Plan	$147 - $2,295	138%
Health Partners Plans (Jefferson Health Plan)	$201	188%
Geisinger	$208	195%
Blue Cross Blue Shield	$326 - $2,165	305%
Upmc Work Partners	$713	668%
Multiplan	$829 - $3,916	776%
Preferred Healthcare System	$3,182	2979%
Coventry/First Health	$3,426	3208%
Fidelis	$3,671	3437%
Intergroup	$3,671 - $4,161	3437%
Health Coalition Partners	$3,916	3666%
Private Health Care Systems	$3,916	3666%
Selectcare	$3,916	3666%
Health Payors Organization	$4,161	3896%
Humana	$4,161	3896%

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 $2,937.
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 UPMC Presbyterian Shadyside 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.