CT scan, neck (cervical spine)
Facility: Hiawatha Community Hospital
Billing Code: 72125 (CPT)
- CPT Billing Code: 72125
- Insurance Median: $1,032
- Cash Discount Price: $1,325
- vs. Medicare Baseline: 9.66x 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 966% of the Medicare baseline (a markup of 866%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $456 - $480 | 427% |
| UnitedHealthcare | $490 - $1,138 | 459% |
| Aetna | $490 - $1,071 | 459% |
| Humana | $495 | 463% |
| Ambetter / Centene | $588 | 551% |
| Oscar - All Plans | $994 | 931% |
| Centrus Health Direct - All Plans | $994 | 931% |
| Preferred Hlth - All Plans | $1,192 | 1116% |
| Cigna | $1,259 | 1179% |
| Wppa Providrs Care - All Plans | $1,259 | 1179% |
| Midlands Choice - All Plans | $1,285 | 1203% |
| Multiplan - All Plans | $1,285 | 1203% |
| Healthy Blue Mcaid - All Plans | $1,325 | 1241% |
Consumer Guidance & Cost Commentary
For a CT scan of the neck at Hiawatha Community Hospital, the cash price is $1,325, which matches the facility's gross charge and the Medicare benchmark of $1,06.81. While the hospital's negotiated rates with major insurers like Blue Cross Blue Shield and UnitedHealthcare range from $456 to $1,138, these amounts are often higher than the cash price due to administrative costs and contract structures. Patients with high-deductible plans may find it financially beneficial to pay the cash rate of $1,325 upfront, as this avoids the administrative overhead and potential balance billing associated with insurance claims. To secure the lowest possible cost, it is recommended to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full within a short window.
The facility is located in Hiawatha, Kansas, and operates as a Critical Access Hospital with a voluntary non-profit ownership structure. While specific county or state average pricing data was not provided in this report, the Medicare benchmark of $1,06.81 serves as a reliable baseline for evaluating the facility's pricing markup. Commercial negotiated rates typically average between 200% and 300% of the Medicare rate, though fair pricing is often defined as 120% to 150%. Consumers should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, but it is crucial to verify network status and request an itemized bill to ensure no unexpected charges are applied. Always review