X-ray, ankle
Facility: Lmh
Billing Code: 73610 (CPT)
- CPT Billing Code: 73610
- Insurance Median: $195
- Cash Discount Price: $168
- vs. Medicare Baseline: 2.19x 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 219% of the Medicare baseline (a markup of 119%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $49 - $581 | 55% |
| UnitedHealthcare | $49 - $596 | 55% |
| Cigna | $88 - $600 | 99% |
| Medicare (plans) | $88 | 99% |
| Haskell Indian Health Services | $88 | 99% |
| Humana | $88 | 99% |
| Allwell | $89 | 100% |
| Ambetter / Centene | $136 | 153% |
| Aetna | $286 - $745 | 322% |
| Non Contracted | $359 - $718 | 404% |
| First Health | $418 - $835 | 470% |
Consumer Guidance & Cost Commentary
For the X-ray, ankle procedure (CPT 73610), the facility's cash median rate of $168.00 is significantly lower than the gross charge of $674.00, offering a potential savings for patients with high-deductible plans or those paying out-of-pocket. While the facility's negotiated rates with major payers like Blue Cross Blue Shield and UnitedHealthcare range from $49 to $596, these amounts often exceed the cash price due to administrative overhead and contract structures. It is important to note that commercial negotiated rates frequently average between 200% and 300% of the Medicare benchmark, whereas fair pricing is typically defined as 120% to 150% of this baseline. In this case, the Medicare amount of $88.91 serves as the objective cost baseline; the cash rate of $168.00 represents approximately 189% of the Medicare benchmark, which aligns closely with the upper end of the fair pricing range and avoids the significant markups often seen in commercial contracts.
Patients should proactively inquire about "self-pay" or "prompt-pay" discounts before scheduling, as hospitals may offer additional fee reductions for upfront payments that bypass costly insurance billing cycles. Although the facility is located in Lawrence, KS (ZIP 66044), the provided data does not include specific county or state average comparisons for this procedure, so local market context cannot be established from this report. However, the facility's ownership by the Government - Local and its rating of 4 out of 5 suggest a commitment to transparency and community service. To ensure you are receiving the most accurate