CMS Price Transparency Data

X-ray, neck (cervical spine)

Facility: Saint Joseph Regional Medical Center - Plymouth

Billing Code: 72040 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72040
  • Insurance Median: $347
  • Cash Discount Price: $354
  • vs. Medicare Baseline: 3.90x Medicare
The contracted insurance negotiated median rate for a X-ray, neck (cervical spine) at Saint Joseph Regional Medical Center - Plymouth is $347. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $354. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 3.90x the Medicare baseline. Located in 1915 Lake Ave, Plymouth, IN.
Cash / Self-Pay
$354

Average discount available for prompt cash payment at this facility.

Insurance Median
$347

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: $354 (398%)
Insurance Median: $347 (390%)
Cash: $354 (398% of Medicare)
Ins. Median: $347 (390% 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 390% of the Medicare baseline (a markup of 290%). 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.

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
Bureau Of Disability $41 46%
Aetna $48 - $354 54%
Blue Cross Blue Shield $48 - $325 54%
Medicaid / KanCare $48 - $66 54%
UnitedHealthcare $48 - $347 54%
Managed Health Services - Indiana $66 74%
Mdwise $66 74%
Medicare (plans) $92 - $94 103%
Meridian Complete $92 103%
Pace-Trinity Health $92 103%
County Coroner $96 108%
Provider Partners Health Plan Of Indiana $101 114%
Auxiant $138 - $452 155%
Physicians Health Plan Northern Indiana Health Insurance $138 - $278 155%
St Joseph County Hlth Dpt $138 155%
Caresource $143 161%
Plain Church Group $147 165%
Siho Insurance Services $147 165%
Key Benefit Administrator $166 - $381 187%
Allied Benefit Systems $175 - $354 197%
Custom Design Benefits $198 223%
Notre Dame Athletic Association $299 336%
Wc Notre Dame $299 336%
Luminare Health (Detroit) $310 - $326 349%
Blue Benefit Administrators Of Massachusetts $325 366%
Blue Care Network $325 366%
Blue Distinction Transplant $325 366%
Blue Shield - Ca $325 366%
Blue Shield - Id (Regence) $325 366%
Blue Shield - Ny Highmark Northeastern $325 366%
Blue Shield - Ny Highmark Western $325 366%
Blue Shield - Pa (Highmark) $325 366%
Blue Shield - Wa (Regence) $325 366%
Ameriben $326 367%
Geha $347 390%
Healthscope $347 390%
Student Insurance Cma $347 390%
Asr Health Benefits $354 398%
Christian Brother Services $354 398%
Employee Benefit Management $354 398%
Medical Mutual $354 398%
Meritain $354 398%
Preferred One $354 398%
Rural Carrier Health Benefit Plan $354 398%
Webtpa $354 398%
Encore Health $381 429%
Indiana Criminal Justice Inst $381 429%
Western & Southern Financial Group $381 429%
Cigna $392 441%
Group Administrators $392 441%
Health Partners $392 441%
Mvp $392 441%
Prairie States $392 441%
Priority Health $392 441%
Professional Benefit Administrators $392 441%
Sagamore Health Network $392 - $419 441%
Sisco Benefits $392 441%
Unified Group Services $392 441%
Goshen Preferred Network $419 - $468 471%
Signature Care $452 508%
Allied National Global Care $490 551%
Asrm - Reliance Standard Life Insurance $490 551%
Avmed Health Plan $490 551%
Christian Care Ministry $490 551%
Dean Health $490 551%
Fallon Health $490 551%
Family Life Insurance Company $490 551%
Freedom Life Insurance Company $490 551%
Ghc Scw $490 551%
International Benefit Administrators $490 551%
Lifetime Benefit Solutions $490 551%
Manhattan Life $490 551%
Medi Share $490 551%
Multiplan $490 551%
Pai $490 551%
Pan-American Life $490 551%
Paramount Hmo $490 551%
Phcs $490 551%
Philadelphia American Life Insurance $490 551%
Trinity Health Share $490 551%
Bankers Life Casualty $544 612%
Wc Align Network $544 612%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1915 Lake Ave, Plymouth, IN 46563
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals