CT scan, neck (cervical spine)
Facility: Wichita County Health Center
Billing Code: 72125 (CPT)
- CPT Billing Code: 72125
- Insurance Median: $1,144
- Cash Discount Price: $1,003
- vs. Medicare Baseline: 10.71x 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 1071% of the Medicare baseline (a markup of 971%). 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 |
|---|---|---|
| Medicaid / KanCare | $1,035 | 969% |
| UnitedHealthcare | $1,254 | 1174% |
Consumer Guidance & Cost Commentary
For this CT scan of the cervical spine at Wichita County Health Center in Leoti, Kansas, the most significant benchmark is the gross charge of $1,254, which serves as the facility's maximum list price. While the facility is a government-owned Critical Access Hospital, the actual price patients pay varies significantly based on payment method. The cash median price is $1,003, while the median negotiated rate for in-network insurance is $1,144, and the median paid rate is $1,035. These figures reflect the difference between the full chargemaster list price and the contracted amounts with payers like Medicaid/KanCare and UnitedHealthcare, where both plans resulted in a single allowed amount of $1,035 and $1,254 respectively.
When comparing these rates to federal standards, the Medicare amount for this procedure is $106.81, indicating that the commercial rates charged are substantially higher than the federal baseline used for cost-basis evaluation. For patients with high-deductible plans, paying the cash median of $1,003 upfront could be more cost-effective than the negotiated rate of $1,144 if their insurance deductible has not yet been met. It is important to note that while the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, patients should still verify their specific plan details and ask the hospital about any self-pay or prompt-pay discounts before scheduling. To ensure accuracy and avoid unexpected costs, consumers are encouraged to request a full itemized bill rather than accepting a summary invoice, as detailed line-by-line reviews can identify errors such as unbundled codes or services not rendered.