X-ray, neck (cervical spine)
Facility: Kiowa County Memorial Hospital
Billing Code: 72040 (CPT)
- CPT Billing Code: 72040
- Insurance Median: $223
- Cash Discount Price: $213
- vs. Medicare Baseline: 2.51x 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 251% of the Medicare baseline (a markup of 151%). 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 | $160 - $222 | 180% |
| UnitedHealthcare | $200 - $250 | 225% |
| Health Partners Of Ks-All Plans | $220 | 247% |
| Humana | $222 | 250% |
| Aetna | $222 | 250% |
| Celtic Comml Exchange-All Other Plans | $222 | 250% |
| Medica Prime Mcare Cost-All Plans | $222 | 250% |
| Medicaid / KanCare | $250 | 281% |
| Providrs Care/Wppa-All Plans | $375 | 422% |
Consumer Guidance & Cost Commentary
For the CPT code 72040, representing an X-ray of the cervical spine, Kiowa County Memorial Hospital in Greensburg, KS, lists a gross charge of $250.00. While the facility's cash median price is $213.00 and the median negotiated rate for in-network payers is $223.00, these figures are significantly higher than the Medicare benchmark of $88.91. Under Medicare benchmarking principles, commercial rates often average 200% to 300% of the Medicare rate, whereas fair pricing is typically defined as 120% to 150%. In this case, the cash price exceeds the Medicare rate by approximately 139%, and the negotiated rates exceed it by roughly 150%, indicating that the facility's pricing aligns closely with the upper end of the "fair pricing" range relative to the federal baseline.
Patients should be aware that insurance negotiated rates can sometimes exceed cash prices due to administrative costs and contract structures, making cash payment a potentially more cost-effective option for those with high-deductible plans. To minimize out-of-pocket expenses, individuals should verify their specific plan's allowed amount before scheduling and inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can range from 20% to 50% for upfront payments. Additionally, since the No Surprises Act prohibits balance billing for emergency care and non-emergency services at in-network facilities, patients should request an itemized billing audit if they receive a bill that appears to include charges for services not rendered or unbundled components, ensuring they are only paying for the actual