CT scan, neck (cervical spine)
Facility: Fredonia Regional Hospital
Billing Code: 72125 (CPT)
- CPT Billing Code: 72125
- Insurance Median: $545
- Cash Discount Price: $606
- vs. Medicare Baseline: 5.10x 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 510% of the Medicare baseline (a markup of 410%). 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 | $300 - $480 | 281% |
| Aetna | $309 - $545 | 289% |
| UnitedHealthcare | $309 - $545 | 289% |
| Veterans Programs - All Plans | $309 | 289% |
| Cigna | $545 | 510% |
| Reserve National-All Plans | $545 | 510% |
| Meritain-All Plans | $545 | 510% |
Consumer Guidance & Cost Commentary
For this CT scan of the cervical spine at Fredonia Regional Hospital in Kansas, the cash price is $606.00, which matches the facility's median negotiated rate. While the hospital is a Critical Access Hospital with government ownership, the cash price is significantly higher than the Medicare benchmark of $106.81, reflecting a markup common in commercial billing. It is important to note that for patients with high-deductible plans, paying the cash price of $606.00 upfront can sometimes be more cost-effective than relying on insurance, as the negotiated rate of $545.00 may still result in substantial out-of-pocket costs if the patient's deductible has not yet been met.
Patients should verify their specific plan details before scheduling, as the allowed amounts vary by insurer, ranging from $300 to $545. Although the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it is crucial to request a self-pay or prompt-pay discount prior to check-in to avoid unexpected charges. Since over 80% of hospital bills contain errors, consumers are encouraged to request a full itemized CPT-coded bill to review every charge, ensuring no services were unbundled or rendered incorrectly before finalizing payment.