X-ray, lower back
Facility: Ellinwood District Hospital
Billing Code: 72110 (CPT)
- CPT Billing Code: 72110
- Insurance Median: $224
- Cash Discount Price: $272
- vs. Medicare Baseline: 2.10x 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 210% of the Medicare baseline (a markup of 110%). 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 |
|---|---|---|
| Humana | $224 | 210% |
| Cigna | $224 | 210% |
| UnitedHealthcare | $224 | 210% |
| Aetna | $224 | 210% |
| Blue Cross Blue Shield | $224 | 210% |
Consumer Guidance & Cost Commentary
For the X-ray of the lower back at Ellinwood District Hospital in Ellinwood, KS, the facility's cash median price is $272.00, while the negotiated rate for in-network insurance plans is $224.00. In this specific case, paying out-of-pocket directly is actually more expensive than what commercial payers like Humana, Cigna, and UnitedHealthcare have agreed to pay. This highlights a common billing dynamic where administrative costs and contract structures can make insurance rates higher than cash prices, even though the facility is a Critical Access Hospital. Patients with high-deductible plans should consider whether paying the cash price of $272.00 upfront might be more cost-effective than relying on insurance, especially if their deductible has not yet been met or if the negotiated rate exceeds their expected out-of-pocket maximum.
The facility's negotiated rate of $224.00 is significantly higher than the Medicare benchmark of $106.81 for this procedure, reflecting a markup typical of commercial pricing models. While the data does not provide specific state or county average comparisons for this exact code, it is important to understand that commercial rates often range from 200% to 300% of Medicare amounts, whereas fair pricing is generally considered to be between 120% and 150%. To potentially lower your bill, patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the total cost by 20% to 50% if paid in full before or shortly after the service. Additionally, since the No Surprises Act prohibits balance billing for emergency care and non-emergency