CMS Price Transparency Data
CT scan, neck (cervical spine)
Facility: Saint Alphonsus Medical Center Ontario
Billing Code: 72125 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 72125
- Insurance Median: $600
- Cash Discount Price: $1,299
- vs. Medicare Baseline: 5.62x Medicare
The contracted insurance negotiated median rate for a CT scan, neck (cervical spine) at Saint Alphonsus Medical Center Ontario is $600. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,299. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.62x the Medicare baseline. Located in 351 Sw 9Th Street, Ontario, OR.
Cash / Self-Pay
$1,299
Average discount available for prompt cash payment at this facility.
Insurance Median
$600
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: $1,299 (1216%)
Insurance Median: $600 (562%)
Cash: $1,299 (1216% of Medicare)
Ins. Median: $600 (562% 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 562% of the Medicare baseline (a markup of 462%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicaid / KanCare | $102 - $600 | 95% |
| Blue Cross Blue Shield | $122 - $1,699 | 114% |
| Medicare (plans) | $122 - $131 | 114% |
| UnitedHealthcare | $122 - $1,919 | 114% |
| Aetna | $126 - $1,893 | 118% |
| American Health Advantage Of Idaho | $127 | 119% |
| Moda Health | $242 - $1,939 | 227% |
| Blue Benefit Administrators Of Massachusetts | $312 | 292% |
| Blue Care Network | $312 | 292% |
| Blue Distinction Transplant | $312 | 292% |
| Blue Shield - Ca | $312 | 292% |
| Blue Shield - Id (Regence) | $312 | 292% |
| Blue Shield - Ny Highmark Northeastern | $312 | 292% |
| Blue Shield - Ny Highmark Western | $312 | 292% |
| Blue Shield - Pa (Highmark) | $312 | 292% |
| Blue Shield - Wa (Regence) | $312 | 292% |
| Healthcare Management Admin | $321 | 301% |
| Webtpa | $329 - $1,799 | 308% |
| Pacificsource Health Plans | $396 - $1,879 | 371% |
| Ada County Jail Inmate Ins | $600 | 562% |
| Ambetter / Centene | $600 | 562% |
| Amish Mennonite | $600 | 562% |
| Bcccp-Michigan | $600 | 562% |
| Bccp | $600 | 562% |
| Bmc Healthnet | $600 | 562% |
| Breast Grant-Connecticut | $600 | 562% |
| California Health And Wellness | $600 | 562% |
| Cardinal Innovations Lme | $600 | 562% |
| Care Oregon Ohp | $600 | 562% |
| Cencal Health Plan | $600 | 562% |
| Cenpatico | $600 | 562% |
| Centurion Of Idaho | $600 | 562% |
| Chhuny | $600 | 562% |
| Childrens Comm Health Plan | $600 | 562% |
| Childrens Medical Services Title 19 | $600 | 562% |
| Cigna | $600 - $1,879 | 562% |
| Community Benefit Health | $600 | 562% |
| Community Care Behavorial Health | $600 | 562% |
| Community Health Choice | $600 | 562% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $600 | 562% |
| Dean Wi Badgercare | $600 | 562% |
| Delaware First Health | $600 | 562% |
| Delta Dental Nj | $600 | 562% |
| Dph Tb Program | $600 | 562% |
| Dscc | $600 | 562% |
| Eastpointe Lme | $600 | 562% |
| Family Health Network | $600 | 562% |
| Freedom First Healthcare | $600 | 562% |
| Ghc Scw Wi Badgercare | $600 | 562% |
| Harbor Health | $600 | 562% |
| Health Safety Net | $600 | 562% |
| Healthy Blue Ne | $600 | 562% |
| Hennepin Health | $600 | 562% |
| Humana | $600 - $1,759 | 562% |
| Id County Ada | $600 | 562% |
| Id County Canyon | $600 | 562% |
| Id County Cat Fund | $600 | 562% |
| Id County Payette | $600 | 562% |
| Idaho Womens Health Check | $600 | 562% |
| Indiana Breast Cervical Cancer | $600 | 562% |
| Inland Empire Health Plan | $600 | 562% |
| Intercommunity Health Ohp | $600 | 562% |
| Iowa Total Care | $600 | 562% |
| Jai Medical System | $600 | 562% |
| Kern Family Health Plan | $600 | 562% |
| Keystone First | $600 | 562% |
| Keystone First Chip | $600 | 562% |
| La Care Health Plan | $600 | 562% |
| Lakeland Care Inc | $600 | 562% |
| Managed Health Services - Indiana | $600 | 562% |
| Maryland Breast & Cervical Program | $600 | 562% |
| Maryland Healthy Smiles - Scion Dental | $600 | 562% |
| Maryland Physicians Care | $600 | 562% |
| Massachusetts Behavioral Health Partnership | $600 | 562% |
| Mdwise | $600 | 562% |
| Medi-Cal | $600 | 562% |
| Medi-Cal Healthnet | $600 | 562% |
| Medstar Dc Healthy Family | $600 | 562% |
| Medstar Md Health Choice | $600 | 562% |
| Mo Home State Health Plan | $600 | 562% |
| Molina Centennial Care | $600 | 562% |
| Nascentia Health Options | $600 | 562% |
| Nebraska Total Care | $600 | 562% |
| New York Cancer Services Program | $600 | 562% |
| Nextlevel Health | $600 | 562% |
| Oregon Screenwise | $600 | 562% |
| Pace Of Southwest Michigan | $600 | 562% |
| Paramount Advantage | $600 | 562% |
| Parkland Community Health Plan | $600 | 562% |
| Partners Behavioral Lme | $600 | 562% |
| Peach State Healthplan | $600 | 562% |
| Presbyterian Centennial Care | $600 | 562% |
| Prestige Health Choice | $600 | 562% |
| Priority Partners | $600 | 562% |
| Rx 340B Pass Along | $600 | 562% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $600 | 562% |
| Rx Medi-Cal | $600 | 562% |
| Rx Meridian Rx | $600 | 562% |
| Sandhills Center Lme | $600 | 562% |
| Screening For Life | $600 | 562% |
| Sunshine State Health Plan | $600 | 562% |
| Superior Health | $600 | 562% |
| Tenncare | $600 | 562% |
| Texas Children'S Health Plan | $600 | 562% |
| Trillium Community Ohp | $600 | 562% |
| Tufts Health Public Plans | $600 | 562% |
| Vaya Health Lme | $600 | 562% |
| Wellsense Health Plan | $600 | 562% |
| Wi Womens Wellness | $600 | 562% |
| Selecthealth | $643 - $1,799 | 602% |
| Mountain Health Co-Op | $1,199 | 1123% |
| Allegiance | $1,519 | 1422% |
| Correctional Health Partners | $1,559 | 1460% |
| Columbia Health Network | $1,599 | 1497% |
| Healthnet | $1,679 | 1572% |
| Allied National Global Care | $1,799 | 1684% |
| Asrm - Reliance Standard Life Insurance | $1,799 | 1684% |
| Christian Care Ministry | $1,799 | 1684% |
| Dean Health | $1,799 | 1684% |
| Fallon Health | $1,799 | 1684% |
| Family Life Insurance Company | $1,799 | 1684% |
| First Choice Health | $1,799 | 1684% |
| Ghc Scw | $1,799 | 1684% |
| International Benefit Administrators | $1,799 | 1684% |
| Lifetime Benefit Solutions | $1,799 | 1684% |
| Manhattan Life | $1,799 | 1684% |
| Pai | $1,799 | 1684% |
| Pan-American Life | $1,799 | 1684% |
| Paramount Hmo | $1,799 | 1684% |
| Phcs | $1,799 | 1684% |
| Trinity Health Share | $1,799 | 1684% |
| Lifewise | $1,859 | 1740% |
| Priority Health | $1,879 | 1759% |
| Allied Benefit Systems | $1,893 | 1772% |
| Ameriben | $1,893 | 1772% |
| Asr Health Benefits | $1,893 | 1772% |
| Christian Brother Services | $1,893 | 1772% |
| Geha | $1,893 - $1,919 | 1772% |
| Healthez | $1,893 | 1772% |
| Luminare Health (Detroit) | $1,893 | 1772% |
| Rural Carrier Health Benefit Plan | $1,893 | 1772% |
| First Health | $1,899 | 1778% |
| Medi Share | $1,899 | 1778% |
| Providence | $1,899 | 1778% |