CMS Price Transparency Data

X-ray, neck (cervical spine)

Facility: Down East Community Hospital

Billing Code: 72040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72040
Insurance Median: $156
Cash Discount Price: $229
vs. Medicare Baseline: 1.75x Medicare

The contracted insurance negotiated median rate for a X-ray, neck (cervical spine) at Down East Community Hospital is $156. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $229. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 1.75x the Medicare baseline. Located in 11 Hospital Drive, Machias, ME.

Cash / Self-Pay

$229

Average discount available for prompt cash payment at this facility.

Insurance Median

$156

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: $229 (258%)

Insurance Median: $156 (175%)

Cash: $229 (258% of Medicare)

Ins. Median: $156 (175% 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
Blue Cross Blue Shield	$38 - $423	43%
Humana	$38 - $231	43%
Wellcare	$38 - $231	43%
Partners Direct Health	$44 - $262	49%
Community Health Options	$72 - $434	81%
Aetna	$73 - $438	82%
UnitedHealthcare	$75 - $451	84%
Cigna	$78 - $473	88%
Martins Point	$78 - $472	88%
Patients Advocates	$78 - $472	88%
Harvard Pilgrim	$80 - $479	90%

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 $229.
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 Down East Community 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.