CT scan, neck (cervical spine)
Facility: Smith County Memorial Hospital
Billing Code: 72125 (CPT)
- CPT Billing Code: 72125
- Insurance Median: $660
- Cash Discount Price: $703
- vs. Medicare Baseline: 6.18x 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 618% of the Medicare baseline (a markup of 518%). 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 | $453 | 424% |
| Medicaid / KanCare | $492 - $703 | 461% |
| Multiplan-All Plans | $632 | 592% |
| Wppa-All Plans | $660 | 618% |
| Health Partners Of Ks Ppo-All Plans | $667 | 624% |
| UnitedHealthcare | $667 | 624% |
| Midlands Choice-All Plans | $667 | 624% |
Consumer Guidance & Cost Commentary
For the CT scan of the cervical spine at Smith County Memorial Hospital in Smith Center, Kansas, the cash price is $703.00, which matches the facility's gross charge and the median amount paid by Medicaid/KanCare plans. While the facility is a Critical Access Hospital owned by the local government, the negotiated rates for in-network payers like Blue Cross Blue Shield and Multiplan-All Plans range from $453 to $703, with a median negotiated payment of $660.00. It is important to note that cash-pay rates can sometimes be more advantageous for patients with high-deductible plans if their insurance negotiated rate exceeds the cash price, though in this specific case, the cash price is identical to the highest negotiated rate. Patients should always verify "self-pay" or "prompt-pay" discounts with the hospital before scheduling, as these upfront payment incentives can bypass the administrative costs associated with insurance billing cycles.
When evaluating this cost, it is crucial to compare rates against the Medicare benchmark rather than the hospital's inflated chargemaster list. The Medicare amount for this procedure is $106.81, meaning the cash price of $703.00 represents a significant markup over the federal baseline. Although the data does not provide specific state or county average figures for comparison, the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, ensuring that unexpected bills for emergency or non-emergency care are not charged for the difference between the provider's full rate and the insurance allowed amount. If a patient receives an itemized bill, they should request a detailed audit to identify any errors, unbundled codes, or services not rendered