X-ray, ankle
Facility: Regional Medical Center
Billing Code: 73610 (CPT)
- CPT Billing Code: 73610
- Insurance Median: $870
- Cash Discount Price: $263
- vs. Medicare Baseline: 9.79x 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 979% of the Medicare baseline (a markup of 879%). 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 |
|---|---|---|
| Medical Associates Health Plan - Tri | $870 | 979% |
Consumer Guidance & Cost Commentary
For this X-ray, ankle procedure at Regional Medical Center in Manchester, IA, the cash median rate is $263. This facility is a government-owned Critical Access Hospital, and the data reflects a single payer scenario where the negotiated rate is $870 and the median paid amount is $125. While the cash price is notably lower than the negotiated rate, patients should be aware that cash-pay options can sometimes be cheaper for those with high-deductible plans if the insurance negotiated rate exceeds the cash price. It is always advisable to check with the hospital directly for "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can significantly lower out-of-pocket costs.
The pricing data also provides context through Medicare benchmarking, showing a Medicare amount of $88.91 and a comparative ratio of 9.8 against the Medicare rate. Although specific state or county average figures were not included in the provided dataset, understanding that commercial negotiated rates often average 200% to 300% of Medicare while fair pricing is typically defined as 120% to 150% helps patients evaluate markups. If a patient receives a bill that exceeds their insurance allowed amount, they may be subject to balance billing, though the No Surprises Act offers federal protections against unexpected charges for emergency care and non-emergency services from out-of-network providers at in-network facilities. To ensure accuracy, patients should request an itemized billing audit to verify that all charges correspond to services actually rendered and to identify any potential errors or unbundled codes.