CT scan, neck (cervical spine)
Facility: Decatur Health
Billing Code: 72125 (CPT)
- CPT Billing Code: 72125
- Insurance Median: $852
- Cash Discount Price: $1,005
- vs. Medicare Baseline: 7.98x 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 798% of the Medicare baseline (a markup of 698%). 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 | $589 | 551% |
| Wppa/Providrs Care- All Plans | $670 | 627% |
| UnitedHealthcare | $681 - $852 | 638% |
| Humana | $688 | 644% |
| Aetna | $1,005 - $1,116 | 941% |
| Midlands Choice- All Plans | $1,005 | 941% |
| Medicaid / KanCare | $1,128 | 1056% |
Consumer Guidance & Cost Commentary
For this CT scan of the cervical spine at Decatur Health in Oberlin, Kansas, the facility's cash median rate is $1,005, which is notably lower than the negotiated rates charged to most major insurers. While commercial payers like UnitedHealthcare and Aetna have negotiated rates ranging from $681 to $1,128, the cash price offers a significant alternative for patients with high-deductible plans or those without insurance. It is important to note that commercial rates often include administrative overhead and contract markups that can exceed the true cost of care; in this case, the cash rate is roughly 30% lower than the highest negotiated amount. Patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as paying upfront can sometimes bypass the higher insurance negotiated ceilings.
The facility's pricing also provides a clear benchmark against Medicare, which sets the standard for the "true cost" of this procedure at $106.81. The cash rate of $1,005 represents a markup of approximately 8 times the Medicare amount, a figure that aligns with typical commercial pricing dynamics where negotiated rates often range from 200% to 300% of Medicare. However, because the cash price is still lower than the majority of commercial negotiated rates listed here, it remains the most cost-effective option for self-pay patients. To ensure you are receiving the best possible price, always verify your specific plan's allowed amount and request an itemized bill if you receive a summary invoice, as hospitals may bundle charges or include services not rendered.