CMS Price Transparency Data

X-ray, neck (cervical spine)

Facility: Unity Physicians Hospital

Billing Code: 72040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72040
Insurance Median: $7,674
Cash Discount Price: Unavailable
vs. Medicare Baseline: 86.31x Medicare

The contracted insurance negotiated median rate for a X-ray, neck (cervical spine) at Unity Physicians Hospital is $7,674. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 86.31x the Medicare baseline. Located in 4455 Edison Lakes Pkwy, Mishawaka, IN.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,674

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%)

Insurance Median: $7,674 (8631%)

Ins. Median: $7,674 (8631% 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 8631% of the Medicare baseline (a markup of 8531%). 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
Blue Cross Blue Shield	$17 - $23,497	19%
Medicaid / KanCare	$17	19%
Mhs Hoosier Care Connect	$17	19%
Aarp Supplemental	$72 - $15,142	81%
Aetna	$72 - $15,142	81%
Cigna	$72 - $15,142	81%
Department Of Va	$72 - $15,142	81%
Medicare (plans)	$72 - $15,142	81%
Mhs Healthy Indiana Plan	$72 - $15,142	81%
Railroad Retirement	$72 - $15,142	81%
UnitedHealthcare	$72 - $31,752	81%
Three Rivers Provider Network	$87 - $18,171	98%
Humana	$101 - $31,000	114%
Encore	$130 - $27,256	146%
Provider Network Of America	$144 - $30,284	162%
Nalc	$155 - $31,752	174%
Sagamore Health Network	$155 - $31,752	174%
Multiplan	$167	188%
Multiplan Wc	$206	232%
All Savers	$31,752	35713%
Medica	$31,752	35713%
Medica Ifb	$31,752	35713%
Oxford	$31,752	35713%

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 $X.
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 Unity Physicians 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.