CT scan, neck (cervical spine)
Facility: Kiowa District Hospital
Billing Code: 72125 (CPT)
- CPT Billing Code: 72125
- Insurance Median: $816
- Cash Discount Price: $691
- vs. Medicare Baseline: 7.64x 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 764% of the Medicare baseline (a markup of 664%). 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 |
|---|---|---|
| Healthchoice-All Plans | $224 | 210% |
| Tricare | $337 | 316% |
| Blue Cross Blue Shield | $453 | 424% |
| UnitedHealthcare | $691 - $864 | 647% |
| Health Partners Of Ks-All Plans | $760 | 712% |
| Humana | $780 | 730% |
| Multiplan-All Plans | $812 | 760% |
| Gbs Insurance - All Plans | $812 | 760% |
| Triwest-All Plans | $821 | 769% |
| Medicare (plans) | $821 | 769% |
| Aetna | $821 | 769% |
| Medicaid / KanCare | $864 | 809% |
| Providers Care (Wppa)-All Plans | $1,296 | 1213% |
| Liberty Healthshare-All Plans | $1,395 | 1306% |
Consumer Guidance & Cost Commentary
For the CPT code 72125, representing a CT scan of the cervical spine, the facility's cash median rate is $691.00, which is lower than the negotiated rates paid by most commercial payers. While the gross charge listed is $864.00, patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as many commercial negotiated rates exceed this amount. For instance, UnitedHealthcare's negotiated range spans from $691 to $864, and several other payers, including Humana and Triwest, have fixed negotiated rates of $780 and $821 respectively. To minimize out-of-pocket costs, it is advisable to confirm with the hospital whether "self-pay" or "prompt-pay" discounts are available, as these programs can offer significant fee reductions for upfront payment.
When evaluating the true cost of this service, it is important to compare rates against the Medicare benchmark rather than the inflated chargemaster list. The Medicare amount for this procedure is $106.81, which serves as the objective baseline for fair pricing; commercial negotiated rates typically average 200% to 300% of this figure, whereas fair pricing is generally defined as 120% to 150%. In this case, the cash rate of $691.00 represents a significant markup over the Medicare rate, reflecting the administrative costs and risk associated with commercial billing. Additionally, while the facility is a Critical Access Hospital in Kiowa, KS, and is owned by a Government Hospital District, patients should be aware that balance billing protections under the No Sur