X-ray, neck (cervical spine)
Facility: Regional Medical Center
Billing Code: 72040 (CPT)
- CPT Billing Code: 72040
- Insurance Median: $870
- Cash Discount Price: $310
- 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 of the cervical spine at Regional Medical Center in Manchester, Iowa, the cash payment rate of $310 is significantly lower than the facility's gross charge of $387 and the Medicare benchmark of $88.91. While the facility is a Critical Access Hospital with a government-local ownership structure, patients should note that commercial negotiated rates from Medical Associates Health Plan - Tri are set at $870, which is higher than the cash price. This pricing structure highlights a common scenario where paying out-of-pocket may be more cost-effective than using insurance, particularly for patients with high-deductible plans who would otherwise face the full negotiated rate of $870.
To ensure you are receiving the most favorable rate, it is recommended to explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling your appointment, as these incentives can further reduce the $310 cash median. Since the facility is an in-network provider for Medical Associates Health Plan - Tri, balance billing is not expected for this service, but patients should still verify their deductible status to understand their out-of-pocket responsibility. Always request a full itemized bill before finalizing payment, as summary invoices can sometimes obscure specific charges, and remember that commercial rates often include administrative overhead that exceeds the actual cost basis represented by the Medicare rate.