X-ray, neck (cervical spine)
Facility: Nemaha Valley Community Hospital
Billing Code: 72040 (CPT)
- CPT Billing Code: 72040
- Insurance Median: $156
- Cash Discount Price: $264
- vs. Medicare Baseline: 1.75x 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.
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 | $129 | 145% |
| Va Ccn - All Plans | $129 | 145% |
| Aetna | $130 - $249 | 146% |
| Celtic Comm Exch - All Plans | $142 | 160% |
| Partners Direct Health - All Plans | $152 | 171% |
| Blue Cross Blue Shield | $160 | 180% |
| Multiplan - All Plans | $264 | 297% |
| Midlands Choice - All Plans | $278 | 313% |
| Health Partners - All Plans | $278 | 313% |
Consumer Guidance & Cost Commentary
For the X-ray of the cervical spine at Nemaha Valley Community Hospital in Seneca, Kansas, the cash median price is $264, which is notably higher than the facility's negotiated rate of $152. While commercial payers like Aetna and Multiplan have negotiated rates ranging from $130 to $278, patients with high-deductible plans may find the cash price more advantageous if their insurance negotiated rate exceeds $264. It is important to remember that commercial rates often include administrative overhead and contract markups, whereas cash prices reflect the direct cost of the service. To ensure you are receiving the best possible rate, always ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these can significantly reduce the final amount owed.
This procedure's pricing is evaluated against federal benchmarks to ensure transparency. The Medicare amount for this service is $88.91, and the facility's cash rate of $264 represents a markup of 1.8 times the Medicare rate. While commercial negotiated rates typically average between 200% and 300% of Medicare, fair pricing is generally defined as 120% to 150% of the Medicare amount. If you receive an itemized bill that includes unexpected charges or broad category summaries, request a full line-by-line audit to identify errors, unbundled codes, or services not rendered. Disputing billing errors should be done in writing to ensure corrections are properly recorded, protecting you from overcharges and potential debt.