CT scan, neck (cervical spine)
Facility: Hospital District #6 Patterson Health Center
Billing Code: 72125 (CPT)
- CPT Billing Code: 72125
- Insurance Median: $855
- Cash Discount Price: $760
- vs. Medicare Baseline: 8.00x 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 800% of the Medicare baseline (a markup of 700%). 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 | $430 - $453 | 403% |
| UnitedHealthcare | $855 - $950 | 800% |
| Providers Care (Wppa)-All Plans | $1,662 | 1556% |
Consumer Guidance & Cost Commentary
For a CT scan of the cervical spine at the Hospital District #6 Patterson Health Center in Anthony, KS, the facility's cash median rate is $760, which is lower than the negotiated rates paid by UnitedHealthcare at $855. While the facility is a Critical Access Hospital with government ownership, patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as the insurer's negotiated rate exceeds the cash amount. It is important to note that cash-pay options can sometimes result in lower out-of-pocket costs if the insurance allowed amount is higher than the self-pay price, so verifying the specific "self-pay" or "prompt-pay" discount available before scheduling is essential for minimizing expenses.
The Medicare benchmark for this service is $106.81, which serves as the objective baseline for evaluating pricing markups. Commercial negotiated rates often average 200% to 300% of the Medicare rate, though fair pricing is typically defined as 120% to 150% of this amount. Given that the facility's cash rate of $760 is significantly higher than the Medicare benchmark, patients should be aware of the potential for balance billing if they receive care from out-of-network providers, where the provider may bill the difference between the chargemaster and the insurance allowed amount. To avoid unexpected costs, consumers should request a detailed, itemized bill to check for errors such as unbundled codes or services not rendered, and dispute any balance bills immediately by requesting a No Surprises Act audit rather than paying the full amount out of fear of credit damage.