CMS Price Transparency Data

X-ray, lower back

Facility: Salem Memorial District Hospital

Billing Code: 72110 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72110
  • Insurance Median: $202
  • Cash Discount Price: $306
  • vs. Medicare Baseline: 1.89x Medicare
The contracted insurance negotiated median rate for a X-ray, lower back at Salem Memorial District Hospital is $202. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $306. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.89x the Medicare baseline. Located in Po Box 774, Salem, MO.
Cash / Self-Pay
$306

Average discount available for prompt cash payment at this facility.

Insurance Median
$202

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)
Cash / Self-Pay: $306 (286%)
Insurance Median: $202 (189%)
Cash: $306 (286% of Medicare)
Ins. Median: $202 (189% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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.

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 $75 - $534 70%
Ambetter / Centene $75 - $202 70%
Blue Cross Blue Shield $75 - $564 70%
Humana $75 - $504 70%
Tricare $75 - $202 70%
Triwest $75 - $202 70%
UnitedHealthcare $75 - $202 70%
Veteran'S Affairs $75 - $202 70%
Healthlink $144 - $386 135%
First Health $178 - $475 167%
Mercy - C.B. Management Company/Joplin Supply Company $178 - $475 167%
Mercy - City Of Springfield $178 - $475 167%
Mercy - Clayco $178 - $475 167%
Mercy - Commerce Bank $178 - $475 167%
Mercy - Diversified Plastics $178 - $475 167%
Mercy - Employers Benefit Alliance $178 - $475 167%
Mercy - Evolutions $178 - $475 167%
Mercy - Fabick Cat $178 - $475 167%
Mercy - Firsthealth Network $178 - $475 167%
Mercy - Health Management Network $178 - $475 167%
Mercy - Health Systems Inc $178 - $475 167%
Mercy - Liberty Utilities/Empire District Electric $178 - $475 167%
Mercy - Life Church $178 - $475 167%
Mercy - Missouri State University $178 - $475 167%
Mercy - Prime Health Services $178 - $475 167%
Mercy - Quiktrip Corporation $178 - $475 167%
Mercy - Shinesolar $178 - $475 167%
Mercy - Springfield Public Schools $178 - $475 167%
Mercy - Springfield Remanufacturing $178 - $475 167%
Mercy - Sumnerone $178 - $475 167%
Mercy - Trailiner $178 - $475 167%
Mercy - Walmart Mercy Accountable Care Plan $178 - $475 167%
Mercy-American Healthcare Alliance $178 - $475 167%
Phcs $178 - $504 167%
Cigna $188 - $504 176%
Mercy - Compresults $200 - $534 187%
Mercy - Corvel Corporation $200 - $534 187%
Mercy - Novasys $200 - $534 187%
Mercy - Scurlock Industries $200 - $534 187%
Mercy - Usa Managed Care Organization $200 - $534 187%
Right Choice-Alliance $211 - $564 198%
Right Choice-Regular $215 - $575 201%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: Po Box 774, Salem, MO 65560
  • CMS Rating: ★★★★☆
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Critical Access Hospitals