X-ray, neck (cervical spine)
Facility: Holton Community Hospital
Billing Code: 72040 (CPT)
- CPT Billing Code: 72040
- Insurance Median: $443
- Cash Discount Price: $401
- vs. Medicare Baseline: 4.98x 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 498% of the Medicare baseline (a markup of 398%). 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 | $158 | 178% |
| Aetna | $283 - $534 | 318% |
| UnitedHealthcare | $283 - $534 | 318% |
| Humana | $286 | 322% |
| Kansas Superior Select - All Plans | $289 | 325% |
| Preferred Health Fn Select - All Other Plans | $443 | 498% |
| Preferred Health Professionals | $443 | 498% |
| Preferred Health Freedom | $443 | 498% |
| Wppa Providers - All Plans | $507 | 570% |
| Medicaid / KanCare | $534 | 601% |
Consumer Guidance & Cost Commentary
For the X-ray of the cervical spine at Holton Community Hospital, the negotiated rates paid by insurance carriers range from $158 to $534, with a median negotiated amount of $443. This figure is notably higher than the cash median of $401, illustrating that paying out-of-pocket can sometimes be more cost-effective for patients with high-deductible plans. While the facility is an in-network Critical Access Hospital in Kansas, the data shows that the cash price is lower than the average commercial negotiated rate, which often includes administrative overhead and claims processing costs. Patients should verify their specific plan details, as the allowed amount varies significantly by payer, with some plans paying as low as $158 and others up to $534 for this service.
To minimize costs, patients are encouraged to request a "self-pay" or "prompt-pay" discount before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50%. It is important to avoid balance billing, as the No Surprises Act protects patients from unexpected charges for out-of-network services at in-network facilities. If a discrepancy arises, patients should request a detailed, itemized billing audit to identify any unbundled codes or services not rendered, rather than accepting a summary bill. Ultimately, comparing the facility's cash rate against the Medicare benchmark of $88.91 reveals the true cost basis, showing that the cash price of $401 represents a reasonable market rate compared to the higher commercial negotiated amounts.