CMS Price Transparency Data

CT scan, neck (cervical spine)

Facility: St Josephs Community Hospital West Bend

Billing Code: 72125 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72125
Insurance Median: $1,889
Cash Discount Price: $1,650
vs. Medicare Baseline: 17.69x Medicare

The contracted insurance negotiated median rate for a CT scan, neck (cervical spine) at St Josephs Community Hospital West Bend is $1,889. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,650. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 17.69x the Medicare baseline. Located in 3200 Pleasant Valley Road, West Bend, WI.

Cash / Self-Pay

$1,650

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,889

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: $1,650 (1545%)

Insurance Median: $1,889 (1769%)

Cash: $1,650 (1545% of Medicare)

Ins. Median: $1,889 (1769% 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 1769% of the Medicare baseline (a markup of 1669%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Allwell	$103	96%
Blue Cross Blue Shield	$103 - $2,550	96%
Community Care	$103	96%
Health Partners	$103 - $1,950	96%
Humana	$103	96%
Icare	$103	96%
Molina	$103	96%
Network Health Plan	$103 - $1,033	96%
Security Health Plan Secure Savers	$103	96%
UnitedHealthcare	$103 - $1,565	96%
Aetna	$105 - $2,100	98%
Care Wisconsin	$106	99%
Centivo	$900 - $990	843%
Froedtert South	$1,260	1180%
Chorus Community Health Plan	$1,290	1208%
Sheboygan Employers Health Network	$1,791	1677%
Common Ground	$1,800	1685%
Health Payment Systems	$1,889 - $2,425	1769%
Wisconsin Physician Services	$2,400	2247%
Trilogy	$2,460	2303%
Americas Choice	$2,610	2444%
Healtheos	$2,610	2444%
Multiplan/Private Healthcare Systems	$2,610	2444%
First Health Network	$2,640	2472%
Hfn	$2,700	2528%
Ibsi Passport	$2,700	2528%
Cigna	$2,850	2668%
Healthsmart	$2,850	2668%

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 $1,650.
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 Josephs Community Hospital West Bend 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.