X-ray, neck (cervical spine)
Facility: Ashland Health Center
Billing Code: 72040 (CPT)
- CPT Billing Code: 72040
- Insurance Median: $222
- Cash Discount Price: $178
- vs. Medicare Baseline: 2.50x 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 $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 250% of the Medicare baseline (a markup of 150%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $74 | 83% |
| Compalliance-All Plans | $178 | 200% |
| Health Partners Of Kansas-All Plans | $189 | 213% |
| Multiplan-All Plans | $218 | 245% |
| Health Choice-All Plans | $222 | 250% |
| Medicaid / KanCare | $222 | 250% |
| UnitedHealthcare | $222 | 250% |
| Aetna | $222 | 250% |
| Healthy Blue Mcr Adv - All Other Plans | $222 | 250% |
| Medicare (plans) | $222 | 250% |
| Medica Mcare - All Plans | $222 | 250% |
| Providers Care (Wppa)-All Plans | $333 | 375% |
Consumer Guidance & Cost Commentary
For the X-ray of the cervical spine at Ashland Health Center in Ashland, KS, the facility's negotiated rate of $222.00 matches the median amount paid by insurers and the facility's cash price, which is notably lower at $178.00. This service is billed at the gross charge of $222.00 across all listed payers, including Medicaid/KanCare and Medicare, indicating that the facility does not offer a discounted negotiated rate below the cash price for this procedure. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that paying cash upfront can sometimes result in lower out-of-pocket costs compared to insurance claims, particularly if the insurance negotiated rate exceeds the cash price. Given that the cash price is $178.00, patients with high-deductible plans or those without insurance may save money by requesting a self-pay or prompt-pay discount before scheduling their visit.
The Medicare benchmark for this service is $88.91, which serves as a baseline for evaluating the facility's pricing markup. The facility's rate of $222.00 represents a 2.5x multiplier relative to the Medicare amount, which is significantly higher than the typical fair pricing range of 120% to 150% of Medicare. Although the data provided does not include specific state or county average comparisons for this CPT code, the substantial difference between the Medicare rate and the facility's charge highlights the importance of understanding the true cost of care versus the inflated chargemaster list. Consumers are advised to request an itemized billing audit to ensure no errors, such as unbundled codes or services