X-ray, neck (cervical spine)
Facility: Decatur Health
Billing Code: 72040 (CPT)
- CPT Billing Code: 72040
- Insurance Median: $298
- Cash Discount Price: $351
- vs. Medicare Baseline: 3.35x 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 335% of the Medicare baseline (a markup of 235%). 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 | $206 | 232% |
| Wppa/Providrs Care- All Plans | $234 | 263% |
| UnitedHealthcare | $238 - $298 | 268% |
| Humana | $240 | 270% |
| Aetna | $351 - $390 | 395% |
| Midlands Choice- All Plans | $351 | 395% |
| Medicaid / KanCare | $394 | 443% |
Consumer Guidance & Cost Commentary
For this X-ray of the cervical spine at Decatur Health in Oberlin, KS, the facility's cash price of $351.00 is notably lower than the median negotiated rates paid by major insurers, which range from $206 to $394 depending on the plan. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that their specific insurance coverage will determine the final out-of-pocket cost. For instance, Blue Cross Blue Shield and Wppa/Providers Care have a single plan paying exactly $206 and $234 respectively, whereas UnitedHealthcare has two plans with rates ranging from $238 to $298. If you have a high-deductible plan, paying the cash price of $351.00 upfront might be more cost-effective than relying on insurance, as the negotiated rates for some payers exceed this amount, and the facility may offer prompt-pay discounts for immediate settlement.
To ensure you receive the most favorable rate, it is essential to request a self-pay classification and confirm any prompt-pay discounts before scheduling your visit, as billing systems often default to insurance processing once a card is on file. Additionally, while the facility's cash rate is significantly higher than the Medicare benchmark of $88.91, which serves as the objective baseline for true cost, the commercial negotiated rates reflect the administrative overhead and contract dynamics of the insurance industry. If you receive a bill that appears to include charges for services not rendered or unbundled components, you should request a full itemized audit to identify errors, as over 80% of hospital bills contain discrepancies that can be resolved through formal written disputes