X-ray, ankle
Facility: Decatur Health
Billing Code: 73610 (CPT)
- CPT Billing Code: 73610
- Insurance Median: $207
- Cash Discount Price: $244
- vs. Medicare Baseline: 2.33x 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 233% of the Medicare baseline (a markup of 133%). 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $163 | 183% |
| UnitedHealthcare | $165 - $207 | 186% |
| Humana | $167 | 188% |
| Blue Cross Blue Shield | $179 | 201% |
| Midlands Choice- All Plans | $244 | 274% |
| Aetna | $244 - $271 | 274% |
| Medicaid / KanCare | $274 | 308% |
Consumer Guidance & Cost Commentary
For this X-ray, ankle procedure at Decatur Health in Oberlin, KS, the facility's cash price of $244 is lower than the state average of $271, offering a potential savings for patients with high-deductible plans or those without insurance. While the facility's negotiated rates with major payers like UnitedHealthcare and Aetna range from $165 to $271, these amounts are often higher than the cash price due to administrative costs and contract structures. If you have a high-deductible plan, paying the cash price upfront or requesting a prompt-pay discount before your deductible is met could result in lower out-of-pocket costs compared to your insurance's negotiated rate.
It is important to verify your specific plan's allowed amount, as commercial rates can vary significantly even within the same network. For instance, while UnitedHealthcare's negotiated rate for this service is $165 to $207, other payers like Midlands Choice and Aetna have rates starting at $244. Patients should always request a self-pay or prompt-pay discount prior to scheduling to avoid balance billing, which occurs when a provider bills the difference between their full chargemaster rate and what insurance pays. If you receive a bill exceeding these negotiated or cash rates, you should request an itemized audit to identify any unbundled codes or services not rendered, ensuring you are only paying for the care you received.