CT scan, neck (cervical spine)
Facility: Wamego Health Center
Billing Code: 72125 (CPT)
- CPT Billing Code: 72125
- Insurance Median: $89
- Cash Discount Price: $1,264
- vs. Medicare Baseline: 0.83x 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.
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 | $39 - $107 | 37% |
| Medicaid / KanCare | $40 - $140 | 37% |
| Aetna | $40 - $111 | 37% |
| Providrs Care | $64 - $178 | 60% |
| Tricare | $174 | 163% |
| Blue Cross Blue Shield | $631 - $664 | 591% |
Consumer Guidance & Cost Commentary
For this CT scan of the cervical spine at Wamego Health Center, the most significant benchmark is that the facility's cash median price of $1,264 is substantially lower than the gross charge of $3,160, representing a substantial discount for patients without insurance. While the facility is a voluntary non-profit critical access hospital in Wamego, KS, the data indicates a negotiated rate of $89, which is notably lower than the cash price and suggests that in-network insurance members may pay significantly less than the cash-pay option. It is important to note that commercial payer plans, such as Blue Cross Blue Shield and Medicaid/KanCare, have negotiated rates ranging from $631 to $178, which often exceed the cash price; therefore, patients with high-deductible plans might find paying the $1,264 cash median more cost-effective than relying on their insurance to cover the negotiated rates.
The Medicare amount for this service is $106.81, with a vendor-to-Medicare ratio of 0.8, indicating that the negotiated rates are generally aligned with or below the federal baseline for this procedure. Although the facility rating is not available in the current dataset, the presence of six unique payers including UnitedHealthcare, Aetna, and Tricare highlights the variability in allowed amounts across different insurance plans, with some plans showing a high-low spread between $39 and $178. Consumers should be aware that while the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, it is still prudent to request a self-pay or prompt-pay discount before check-in, as hospitals often offer fee reductions of 2