CMS Price Transparency Data

X-ray, neck (cervical spine)

Facility: Grossmont Hospital

Billing Code: 72040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72040
Insurance Median: $468
Cash Discount Price: $576
vs. Medicare Baseline: 5.26x Medicare

The contracted insurance negotiated median rate for a X-ray, neck (cervical spine) at Grossmont Hospital is $468. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $576. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 5.26x the Medicare baseline. Located in 5555 Grossmont Center Drive Box 58, La Mesa, CA.

Cash / Self-Pay

$576

Average discount available for prompt cash payment at this facility.

Insurance Median

$468

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$88.91

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $88.91 (100%)

Cash / Self-Pay: $576 (648%)

Insurance Median: $468 (526%)

Cash: $576 (648% of Medicare)

Ins. Median: $468 (526% of 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 526% of the Medicare baseline (a markup of 426%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Health Net	$115 - $614	129%
UnitedHealthcare	$215 - $630	242%
San Diego Pace	$234 - $2,603	263%
Blue Shield	$261 - $384	294%
Molina	$261 - $428	294%
Multiplan	$261	294%
Kaiser	$323	363%
Aetna	$384 - $691	432%
Cigna	$388 - $591	436%
Blue Cross Blue Shield	$428 - $591	481%
Medicare (plans)	$461 - $576	519%
Allianz Global Assistance	$468	526%
Interplan	$480	540%
Community Health Group	$538 - $614	605%
Epic Americas	$538	605%
Humana	$576	648%
County Medical Services	$591 - $614	665%
Medi-Cal	$2,603	2928%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $576.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72040.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Grossmont Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72040.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.