X-ray, lower back
Facility: Decatur Health
Billing Code: 72110 (CPT)
- CPT Billing Code: 72110
- Insurance Median: $368
- Cash Discount Price: $434
- vs. Medicare Baseline: 3.45x 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 345% of the Medicare baseline (a markup of 245%). 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $290 | 272% |
| UnitedHealthcare | $294 - $368 | 275% |
| Humana | $297 | 278% |
| Blue Cross Blue Shield | $319 | 299% |
| Aetna | $434 - $483 | 406% |
| Midlands Choice- All Plans | $434 | 406% |
| Medicaid / KanCare | $487 | 456% |
Consumer Guidance & Cost Commentary
For this X-ray of the lower back at Decatur Health in Oberlin, Kansas, the cash price is $434.00, which is lower than the facility's gross charge of $483.00. While the median negotiated rate across payers is $368.00, the cash price remains competitive and aligns closely with the facility's self-pay baseline. Patients with high-deductible plans may find paying out-of-pocket at the cash rate of $434.00 more cost-effective than relying on insurance, as commercial negotiated rates often include administrative overhead that can exceed the direct cash price. It is important to verify your specific plan's deductible status before scheduling, as paying the full negotiated amount may not be necessary if you have already met your out-of-pocket threshold.
This facility, a Critical Access Hospital, has a Medicare benchmark of $106.81, which serves as the objective baseline for evaluating pricing fairness. The cash price of $434.00 represents a significant markup over the Medicare rate, a common dynamic in commercial healthcare where negotiated rates and cash prices reflect the facility's cost structure and local wage indexes. To ensure you are not overcharged, patients should request an itemized billing audit before paying any balance bill, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, if you receive a bill from an out-of-network provider at this in-network facility, you may be eligible for protections under the No Surprises Act, which bans balance billing for emergency and non-emergency services, so you should dispute any unexpected charges immediately rather than accepting them to avoid credit damage.