CMS Price Transparency Data

X-ray, neck (cervical spine)

Facility: Middlesboro Arh Hospital

Billing Code: 72040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72040
Insurance Median: $80
Cash Discount Price: $262
vs. Medicare Baseline: 0.90x Medicare

The contracted insurance negotiated median rate for a X-ray, neck (cervical spine) at Middlesboro Arh Hospital is $80. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $262. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 0.90x the Medicare baseline. Located in 3600 West Cumberland Avenue, Middlesboro, KY.

Cash / Self-Pay

$262

Average discount available for prompt cash payment at this facility.

Insurance Median

$80

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: $262 (295%)

Insurance Median: $80 (90%)

Cash: $262 (295% of Medicare)

Ins. Median: $80 (90% 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.

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
Aetna	$60 - $405	67%
Blue Cross Blue Shield	$60 - $381	67%
Humana	$60 - $80	67%
UnitedHealthcare	$60 - $325	67%
Wellcare Of Kentucky	$60 - $109	67%
Passport Molina	$80	90%
Caresoure Kentucky	$262	295%

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 $262.
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 Middlesboro Arh 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.