CMS Price Transparency Data

CT scan, neck (cervical spine)

Facility: Monroe County Hospital

Billing Code: 72125 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72125
Insurance Median: $995
Cash Discount Price: $1,271
vs. Medicare Baseline: 9.32x Medicare

The contracted insurance negotiated median rate for a CT scan, neck (cervical spine) at Monroe County Hospital is $995. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,271. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 9.32x the Medicare baseline. Located in 6580 165Th Street, Albia, IA.

Cash / Self-Pay

$1,271

Average discount available for prompt cash payment at this facility.

Insurance Median

$995

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: $1,271 (1190%)

Insurance Median: $995 (932%)

Cash: $1,271 (1190% of Medicare)

Ins. Median: $995 (932% 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 932% of the Medicare baseline (a markup of 832%). 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
Wellmark Hmo	$151	141%
Wellmark Ppo - All Other Plans	$162	152%
Mahp Mcare - All Plans	$818 - $961	766%
Tricare	$818 - $961	766%
UnitedHealthcare	$818 - $2,175	766%
Va Ccn - All Plans	$818 - $961	766%
Amerigroup Mcare	$826 - $971	773%
Humana	$826 - $971	773%
Wellmark Mcare	$826 - $971	773%
Aetna	$834 - $2,152	781%
Iowa Total Care Mcaid - All Plans	$973 - $1,144	911%
Molina Mcaid - All Plans	$988 - $1,161	925%
Amerigroup Mcaid - All Other Plans	$1,002 - $1,178	938%
Centivo - All Plans	$1,227 - $1,442	1149%
Midlands Choice - All Plans	$1,363 - $1,602	1276%
Preferred Hlth - All Plans	$1,460 - $1,717	1367%
Geha - All Plans	$1,558 - $1,831	1459%
Multiplan - All Plans	$1,752 - $2,060	1640%
Integrated Hp - All Plans	$1,889 - $2,220	1769%

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 $1,271.
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 Monroe County 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.