CMS Price Transparency Data

CT scan, neck (cervical spine)

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 72125 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72125
Insurance Median: $2,525
Cash Discount Price: $3,224
vs. Medicare Baseline: 23.64x Medicare

The contracted insurance negotiated median rate for a CT scan, neck (cervical spine) at UPMC Children's Hospital of Pittsburgh is $2,525. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,224. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 23.64x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$3,224

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,525

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: $3,224 (3018%)

Insurance Median: $2,525 (2364%)

Cash: $3,224 (3018% of Medicare)

Ins. Median: $2,525 (2364% 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 2364% of the Medicare baseline (a markup of 2264%). 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
Health Plan Of Upper Ohio Valley	$101 - $3,492	95%
Blue Cross Blue Shield	$108 - $2,686	101%
Amerihealth Caritas	$109 - $500	102%
Cigna	$109 - $2,955	102%
Aetna	$112 - $2,955	105%
Upmc Health Plan	$308 - $1,276	288%
UnitedHealthcare	$330 - $2,525	309%
Health Partners Plans (Jefferson Health Plan)	$517	484%
Highmark Wholecare (Prev Gateway)	$539	505%
Pa Health & Wellness	$541	507%
Geisinger	$549 - $2,415	514%
Intergroup	$3,492 - $4,567	3269%
Coventry/First Health	$4,298	4024%
Saudi Armed Forces	$4,298	4024%
Health Payors Organization	$4,567	4276%
Multiplan	$4,567	4276%
National Provider Network	$4,836	4528%
Private Health Care Systems	$4,836	4528%

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 $3,224.
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 Children's Hospital of Pittsburgh 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.