X-ray, lower back
Facility: Holton Community Hospital
Billing Code: 72110 (CPT)
- CPT Billing Code: 72110
- Insurance Median: $632
- Cash Discount Price: $572
- vs. Medicare Baseline: 5.92x 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 592% of the Medicare baseline (a markup of 492%). 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 | $246 | 230% |
| UnitedHealthcare | $404 - $762 | 378% |
| Aetna | $404 - $762 | 378% |
| Humana | $408 | 382% |
| Kansas Superior Select - All Plans | $412 | 386% |
| Preferred Health Fn Select - All Other Plans | $632 | 592% |
| Preferred Health Freedom | $632 | 592% |
| Preferred Health Professionals | $632 | 592% |
| Wppa Providers - All Plans | $724 | 678% |
| Medicaid / KanCare | $762 | 713% |
Consumer Guidance & Cost Commentary
For the X-ray of the lower back (CPT 72110) at Holton Community Hospital in Holton, Kansas, the cash median price is $572.00, which is lower than the facility's negotiated rates of $632.00 paid by most insurers. While the gross charge listed is $762.00, patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as the negotiated rates often exceed the cash amount. It is important to note that the facility is a Critical Access Hospital in a rural setting, and while specific county or state average data was not provided in this report, patients should always verify if their specific insurance plan has a lower allowed amount than the facility's negotiated rate before scheduling.
The Medicare benchmark for this service is $106.81, which serves as a baseline for evaluating pricing fairness; commercial negotiated rates are significantly higher than this federal standard, reflecting the administrative costs and contract structures of private insurance. Although the facility is a voluntary non-profit, the data shows that some payers, such as Medicaid/KanCare, pay the full gross amount of $762.00, while others like Blue Cross Blue Shield pay a fixed rate of $246.00. To minimize costs, patients should inquire about "self-pay" or "prompt-pay" discounts before check-in, as paying the bill in full upfront can sometimes result in a fee reduction that brings the total closer to the cash median of $572.00.