CMS Price Transparency Data

X-ray, neck (cervical spine)

Facility: Adventist Health Castle

Billing Code: 72040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72040
Insurance Median: $194
Cash Discount Price: $103
vs. Medicare Baseline: 2.18x Medicare

The contracted insurance negotiated median rate for a X-ray, neck (cervical spine) at Adventist Health Castle is $194. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $103. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 2.18x the Medicare baseline. Located in 640 Ulukahiki St, Kailua, HI.

Cash / Self-Pay

$103

Average discount available for prompt cash payment at this facility.

Insurance Median

$194

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$88.91

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $88.91 (100%)

Cash / Self-Pay: $103 (116%)

Insurance Median: $194 (218%)

Cash: $103 (116% of Medicare)

Ins. Median: $194 (218% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $88.91 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 218% of the Medicare baseline (a markup of 118%). 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
Multiplan Hmn - All Plans	$15	17%
UnitedHealthcare	$20	22%
Hmsa Hmo	$40	45%
Hmsa Ppo - All Other Plans	$40	45%
Alohacare Quest Mcaid - All Other Plans	$59 - $101	66%
Kfh Mcr Adv	$103	116%
Medicare (plans)	$103	116%
Ohana Health Plan - All Plans	$105	118%
Devoted Hlth Mcr Adv - All Plans	$108	121%
Pacific Admin Ppo - All Plans	$149 - $258	168%
Hwmg/Hmaa - All Plans	$173 - $299	195%
Health Alliance - All Plans	$188 - $325	211%
Mdx Hawaii Ppo - All Plans	$188 - $324	211%
Kfh - All Other Plans	$200 - $345	225%
Uni Health Alliance - All Plans	$219 - $379	246%
First Health Ppo - All Plans	$221 - $382	249%
Medicaid / KanCare	$235 - $406	264%
State Of Hi Nonprofit - All Plans	$411 - $710	462%

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 $103.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72040.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health Castle is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72040.
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.