CT scan, neck (cervical spine)
Facility: Kansas City Orthopaedic Institute
Billing Code: 72125 (CPT)
- CPT Billing Code: 72125
- Insurance Median: $254
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.38x 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 238% of the Medicare baseline (a markup of 138%). 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 |
|---|---|---|
| UnitedHealthcare | $98 | 92% |
| Aetna | $98 | 92% |
| Cigna | $100 | 94% |
| Blue Cross Blue Shield | $254 | 238% |
Consumer Guidance & Cost Commentary
For this CT scan of the cervical spine at the Kansas City Orthopaedic Institute in Leawood, KS, the negotiated rate is $254.00, which aligns exactly with the average paid by Blue Cross Blue Shield across its five plans. This rate is significantly higher than the Medicare benchmark of $106.81, reflecting the standard markup for commercial insurance contracts. While the facility is a physician-owned acute care hospital, the data does not provide specific cash or self-pay rates, so patients cannot yet determine if paying out-of-pocket would result in lower costs. However, it is important to note that cash-pay options can sometimes be cheaper for patients with high-deductible plans if the insurance negotiated rate exceeds the cash price, making it worthwhile to inquire about self-pay or prompt-pay discounts directly with the hospital before scheduling.
Patients should be aware that commercial insurance rates often include administrative overhead and are not necessarily the lowest possible price available. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, unexpected ancillary charges from out-of-network providers can still occur. To avoid surprise costs, consumers should request a full itemized bill before paying, as summary bills may obscure unbundled codes or services not rendered. If a balance bill is received, patients should dispute it with their insurer rather than paying immediately, and they should avoid signing consent waivers that waive their rights to dispute out-of-network charges for emergency or mandatory services.