X-ray, chest (two views)

For the CPT code 71046, representing a chest X-ray with two views, Mercy Hospital Pittsburg, Inc. lists a gross charge of $518.00. While the facility offers a cash median price of $337.00, which is significantly lower than the gross charge, commercial insurance negotiated rates vary widely across payers. For example, Medicaid/KanCare plans pay a median of $88.00, whereas some contracted plans like United Medical Resources and Auxiant pay $349.00 and $414.00 respectively. It is important to note that cash-pay rates can sometimes be more cost-effective for patients with high-deductible plans if their insurance negotiated rate exceeds the cash price. Patients should verify their specific plan's allowed amount before scheduling, as in-network rates are not always the lowest possible option available.

The facility's pricing is benchmarked against Medicare, which sets a standard rate of $88.91 for this procedure. The facility's cash median of $337.00 is approximately 3.8 times the Medicare rate, while the median negotiated rate across all payers is $87.00, which is slightly below the Medicare benchmark. This data suggests that for many commercial payers, the negotiated rate is actually lower than the Medicare allowable, indicating that using insurance may result in lower out-of-pocket costs compared to paying cash. Additionally, patients should be aware of the No Surprises Act protections, which prevent balance billing for out-of-network services at in-network facilities, and should request a full itemized bill to ensure no unbundled codes or services not rendered are included in their final statement