X-ray, neck (cervical spine)
Facility: Hospital District #6 Patterson Health Center
Billing Code: 72040 (CPT)
- CPT Billing Code: 72040
- Insurance Median: $225
- Cash Discount Price: $200
- vs. Medicare Baseline: 2.53x 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 253% of the Medicare baseline (a markup of 153%). 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 | $150 - $158 | 169% |
| UnitedHealthcare | $225 - $250 | 253% |
| Providers Care (Wppa)-All Plans | $438 | 493% |
Consumer Guidance & Cost Commentary
For the X-ray of the cervical spine at Hospital District #6 Patterson Health Center in Anthony, KS, the facility's cash median price is $200, which is lower than the negotiated rates paid by major insurers like UnitedHealthcare ($225) and Providers Care ($438). This price transparency data shows that paying cash upfront can be a more cost-effective strategy for patients with high-deductible plans, as the cash price avoids the administrative markup inherent in insurance billing cycles. While the facility is a Critical Access Hospital owned by the government, patients should explicitly request "self-pay" or "prompt-pay" discounts before scheduling to ensure they receive the lowest possible rate, as hospitals often offer significant fee reductions for upfront payment to bypass costly claims processing.
The facility's negotiated rates are significantly higher than the cash price, with UnitedHealthcare members facing a potential $25 difference compared to the cash median. It is important to note that Medicare, which serves as the objective benchmark for fair pricing, covers this service at $88.91, meaning commercial negotiated rates can sometimes exceed 2.5 times the Medicare amount. Patients should be aware that balance billing is generally prohibited for emergency care under the No Surprises Act, but they must verify their network status and deductible coverage before receiving care to avoid unexpected costs. If a patient receives a bill that appears higher than the negotiated rate, they should request a detailed itemized audit to identify any errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain discrepancies that can be corrected.