CT scan, neck (cervical spine)
Facility: Kansas Heart Hospital
Billing Code: 72125 (CPT)
- CPT Billing Code: 72125
- Insurance Median: $1,665
- Cash Discount Price: $1,166
- vs. Medicare Baseline: 15.59x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 1559% of the Medicare baseline (a markup of 1459%). 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Tricare | $87 | 81% |
| Celtic Mcr Adv | $96 | 90% |
| Humana | $96 | 90% |
| Medicaid / KanCare | $96 - $1,850 | 90% |
| UnitedHealthcare | $96 - $1,850 | 90% |
| Blue Cross Blue Shield | $462 - $1,850 | 433% |
| Wppa - All Plans | $541 | 507% |
| Multiplan - All Plans | $1,665 | 1559% |
| Aetna | $1,804 - $1,850 | 1689% |
| Soonerselect Mcaid - All Plans | $1,850 | 1732% |
| Celtic Mcaid - All Other Plans | $1,850 | 1732% |
Consumer Guidance & Cost Commentary
For a CT scan of the neck at Kansas Heart Hospital in Wichita, the negotiated rates paid by insurance plans range from $87 to $1,850, with a median negotiated amount of $1,665. This median rate is significantly higher than the facility's cash price of $1,166, illustrating that paying out-of-pocket can sometimes result in substantial savings compared to insurance reimbursement. While the facility's cash rate is lower than the state average for this procedure, patients with high-deductible plans should consider that the insurance negotiated rate often exceeds the cash price. To maximize savings, it is advisable to ask the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing costly administrative processing fees.
When evaluating costs, it is important to compare rates against the Medicare benchmark rather than the hospital's full chargemaster list. For this specific code, the Medicare amount is $106.81, and the facility's cash rate of $1,166 represents a markup of 15.6% over the Medicare amount, which falls within the range of fair pricing typically defined as 120% to 150% of Medicare. Commercial negotiated rates, however, often average 200% to 300% of Medicare due to administrative overhead and contract dynamics. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under federal law, but they must request a detailed, itemized bill to verify that no unexpected charges for services not rendered or unbundled components