CMS Price Transparency Data

CT scan, neck (cervical spine)

Facility: St Mary's General Hospital

Billing Code: 72125 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72125
Insurance Median: $163
Cash Discount Price: $123
vs. Medicare Baseline: 1.53x Medicare

The contracted insurance negotiated median rate for a CT scan, neck (cervical spine) at St Mary's General Hospital is $163. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $123. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.53x the Medicare baseline. Located in 350 Boulevard, Passaic, NJ.

Cash / Self-Pay

$123

Average discount available for prompt cash payment at this facility.

Insurance Median

$163

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $123 (115%)

Insurance Median: $163 (153%)

Cash: $123 (115% of Medicare)

Ins. Median: $163 (153% of 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.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Humana	$99	93%
UnitedHealthcare	$109 - $163	102%
Aetna	$124 - $262	116%
Amerihealth	$124 - $447	116%
Clover Health	$124	116%
Medicare (plans)	$124	116%
Horizon	$124 - $219	116%
Wellcare	$124 - $167	116%
Tricare	$124	116%
Wellpoint Amerigroup	$124	116%
Ally-Align (Fka Spartan Plan Nj, Inc.)	$130	122%
Employer Direct Healthcare	$173	162%
Cigna	$182	170%
Fairprice Healthcare Holdings	$198	185%
Coventry	$247	231%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $123.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72125.

Insurance In-Network Protection Plan

Contact your insurance company to confirm St Mary's General Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72125.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.