CMS Price Transparency Data

CT scan, neck (cervical spine)

Facility: Saint Joseph Regional Medical Center

Billing Code: 72125 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72125
  • Insurance Median: $391
  • Cash Discount Price: $2,077
  • vs. Medicare Baseline: 3.66x Medicare
The contracted insurance negotiated median rate for a CT scan, neck (cervical spine) at Saint Joseph Regional Medical Center is $391. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,077. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.66x the Medicare baseline. Located in 5215 Holy Cross Pkwy, Mishawaka, IN.
Cash / Self-Pay
$2,077

Average discount available for prompt cash payment at this facility.

Insurance Median
$391

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: $2,077 (1945%)
Insurance Median: $391 (366%)
Cash: $2,077 (1945% of Medicare)
Ins. Median: $391 (366% 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 366% of the Medicare baseline (a markup of 266%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Aetna $57 - $2,036 53%
Blue Cross Blue Shield $57 - $391 53%
Medicaid / KanCare $57 - $386 53%
UnitedHealthcare $57 - $878 53%
Medicare (plans) $111 - $113 104%
Meridian Complete $111 104%
Pace-Trinity Health $111 104%
County Coroner $115 108%
Provider Partners Health Plan Of Indiana $122 114%
Auxiant $166 - $2,600 155%
Physicians Health Plan Northern Indiana Health Insurance $166 - $334 155%
St Joseph County Hlth Dpt $166 155%
Caresource $171 160%
Siho Insurance Services $177 166%
Key Benefit Administrator $199 - $1,949 186%
Allied Benefit Systems $210 - $2,036 197%
Custom Design Benefits $238 223%
Managed Health Services - Indiana $386 361%
Mdwise $386 361%
Blue Benefit Administrators Of Massachusetts $391 366%
Blue Care Network $391 366%
Blue Distinction Transplant $391 366%
Blue Shield - Ca $391 366%
Blue Shield - Id (Regence) $391 366%
Blue Shield - Ny Highmark Northeastern $391 366%
Blue Shield - Ny Highmark Western $391 366%
Blue Shield - Pa (Highmark) $391 366%
Blue Shield - Wa (Regence) $391 366%
Hospice Of Marshall County $815 763%
Hospice Of St Joseph County $815 763%
Plain Church Group $846 792%
Geha $878 822%
Healthscope $878 822%
Student Insurance Cma $878 822%
Notre Dame Athletic Association $1,723 1613%
Wc Notre Dame $1,723 1613%
Luminare Health (Detroit) $1,786 - $1,880 1672%
Encore Health $1,857 - $1,949 1739%
Ameriben $1,880 1760%
Indiana Criminal Justice Inst $1,949 1825%
Western & Southern Financial Group $1,949 1825%
Cigna $2,005 1877%
Group Administrators $2,005 1877%
Health Partners $2,005 1877%
Mvp $2,005 1877%
Prairie States $2,005 1877%
Priority Health $2,005 1877%
Professional Benefit Administrators $2,005 1877%
Sagamore Health Network $2,005 - $2,318 1877%
Sisco Benefits $2,005 1877%
Unified Group Services $2,005 1877%
Asr Health Benefits $2,036 1906%
Christian Brother Services $2,036 1906%
Employee Benefit Management $2,036 1906%
Medical Mutual $2,036 1906%
Meritain $2,036 1906%
Preferred One $2,036 1906%
Rural Carrier Health Benefit Plan $2,036 1906%
Webtpa $2,036 1906%
Goshen Preferred Network $2,412 - $2,694 2258%
Christian Brothers Holy Cross $2,506 2346%
Signature Care $2,506 2346%
Bankers Life Casualty $3,133 2933%
Bureau Of Disability $3,133 2933%
Wc Align Network $3,133 2933%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 5215 Holy Cross Pkwy, Mishawaka, IN 46545
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals