X-ray, neck (cervical spine)
Facility: Hiawatha Community Hospital
Billing Code: 72040 (CPT)
- CPT Billing Code: 72040
- Insurance Median: $592
- Cash Discount Price: $760
- vs. Medicare Baseline: 6.66x 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 666% of the Medicare baseline (a markup of 566%). 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 | $152 - $160 | 171% |
| Aetna | $281 - $614 | 316% |
| UnitedHealthcare | $281 - $653 | 316% |
| Humana | $284 | 319% |
| Ambetter / Centene | $337 | 379% |
| Centrus Health Direct - All Plans | $570 | 641% |
| Oscar - All Plans | $570 | 641% |
| Preferred Hlth - All Plans | $684 | 769% |
| Wppa Providrs Care - All Plans | $722 | 812% |
| Cigna | $722 | 812% |
| Multiplan - All Plans | $737 | 829% |
| Midlands Choice - All Plans | $737 | 829% |
| Healthy Blue Mcaid - All Plans | $760 | 855% |
Consumer Guidance & Cost Commentary
For the X-ray of the cervical spine at Hiawatha Community Hospital, the cash price is $760.00, which matches the facility's gross charge and the Medicare-approved amount of $88.91 adjusted for local factors. While the hospital's negotiated rates with major payers like Aetna and UnitedHealthcare range from $281 to $653, these amounts are still significantly higher than the cash price. Patients with high-deductible plans or those without insurance may find paying the $760 cash price directly more cost-effective than relying on insurance, as the negotiated rates often exceed the cash rate. To secure the lowest possible price, it is advisable to ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront.
The facility is located in Hiawatha, Kansas, and operates as a Critical Access Hospital. While specific county or state average data was not provided in the report, the cash price of $760.00 serves as a clear benchmark for comparison against any local averages. It is important to note that commercial insurance rates are often inflated by administrative costs and contract structures, sometimes reaching 200% to 300% of the Medicare rate, whereas fair pricing is typically defined as 120% to 150%. If you receive a bill from an out-of-network provider at this facility, the No Surprises Act may protect you from balance billing for emergency care or non-emergency services, and you should dispute any unexpected charges in writing rather than paying immediately. Always request a detailed, itemized bill to