CT scan, neck (cervical spine)
Facility: Regional Medical Center
Billing Code: 72125 (CPT)
- CPT Billing Code: 72125
- Insurance Median: $870
- Cash Discount Price: $1,740
- vs. Medicare Baseline: 8.15x 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 815% of the Medicare baseline (a markup of 715%). 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 |
|---|---|---|
| Medical Associates Health Plan - Tri | $870 | 815% |
Consumer Guidance & Cost Commentary
A self-pay patient should know that paying cash for this CPT 72125 CT scan directly can be significantly more cost-effective than using insurance, as the cash median rate of $1,740 exceeds the negotiated rate of $870 paid by Medical Associates Health Plan - Tri. While many patients assume insurance offers the lowest price, the data shows that for this specific procedure, the commercial negotiated rate is actually lower than the cash price, meaning patients with high-deductible plans might save money by paying the negotiated amount through their plan rather than paying the full cash price. It is crucial to verify your specific plan's allowed amount before scheduling, as in-network rates vary by carrier and can sometimes exceed what a patient could pay out-of-pocket.
The broader rate context reveals that the facility's gross charge of $2,175 and the Medicare allowed amount of $106.81 highlight substantial markups compared to federal benchmarks, with the vs_medicare ratio indicating the facility charges 8.1 times the Medicare rate. Although the data does not provide specific state or county average comparisons for this procedure, the significant difference between the gross charge and the cash median suggests that patients should aggressively request itemized billing audits to identify any unbundled codes or services not rendered. Additionally, patients should ask about prompt-pay discounts upfront at registration, as paying in full can sometimes bypass the administrative overhead associated with insurance claims processing and result in a lower final bill than the standard cash rate.