CMS Price Transparency Data

X-ray, neck (cervical spine)

Facility: Mercy Hospital Carthage

Billing Code: 72040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72040
Insurance Median: $232
Cash Discount Price: $275
vs. Medicare Baseline: 2.61x Medicare

The contracted insurance negotiated median rate for a X-ray, neck (cervical spine) at Mercy Hospital Carthage is $232. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $275. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 2.61x the Medicare baseline. Located in 3125 Dr Russell Smith Way, Carthage, MO.

Cash / Self-Pay

$275

Average discount available for prompt cash payment at this facility.

Insurance Median

$232

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: $275 (309%)

Insurance Median: $232 (261%)

Cash: $275 (309% of Medicare)

Ins. Median: $232 (261% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 261% of the Medicare baseline (a markup of 161%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$24 - $376	27%
Humana	$24 - $127	27%
Medicaid / KanCare	$24 - $232	27%
United Medical Resources Contracted [320454]	$44 - $381	49%
UnitedHealthcare	$44 - $368	49%
Blue Cross Blue Shield	$49 - $116	55%
Medicare (plans)	$82 - $125	92%
Cherokee Nation Health Serv Contracted [320066]	$116	130%
Cigna	$116 - $381	130%
Cross Timbers Hospice [20098]	$116	130%
Dept Of Veteran Affairs Contracted [320106]	$116	130%
Elara Caring Aspire Hospice [20433]	$116	130%
Globalhealth Contracted [320145]	$116	130%
Halo Hcr Inc Hospice Contracted [320432]	$116	130%
Halo Hcr Inc Hospice [20432]	$116	130%
Indian Health Service Contracted [320198]	$116	130%
Kindful Hospice Contracted [320434]	$116	130%
Kindful Hospice [20434]	$116	130%
Medical Associates Health Contracted [320444]	$116	130%
Mercy Hospice Okc [20252]	$116	130%
Mercy Mgd Behavioral Health Contracted [320259]	$116	130%
Pace Of The Ozarks Contracted [320518]	$116	130%
Provider Partners Health Plans Contracted [320450]	$116	130%
Qual Choice Contracted [320325]	$116	130%
Tricare	$117	132%
Point C Contracted [320238]	$148 - $381	166%
Health Systems Inc Contracted [320174]	$182	205%
Insurance System Inc Contracted [320465]	$182	205%
Administrative Payor Contracted [320005]	$190	214%
Centivo Contracted [320505]	$195	219%
Healthscope Contracted [320182]	$220	247%
Ambetter / Centene	$232	261%
Home State Health Plan Contracted [320187]	$232	261%
Novasys Contracted [320285]	$232	261%
Benefit Management Contracted [320052]	$254 - $368	286%
Auxiant Contracted [320462]	$275 - $360	309%
Healthlink Contracted [320179]	$275 - $393	309%
Preferred Health Plan Contracted [320522]	$275	309%
Workers Comp [20426]	$338 - $423	380%
90 Degree Benefits Contracted [320436]	$360	405%
Aither Health Contracted [320449]	$360	405%
Ebms Contracted [320493]	$360	405%
Edison Health Solutions Contracted [320502]	$360	405%
Imagine 360 Contracted [320494]	$360	405%
Mercy Benefit Admin Contracted [320251]	$360 - $381	405%
Reflect Health Contracted [320492]	$360	405%
Show-Me Health Administrators Contracted [320483]	$360	405%
Yuzu Health Contracted [320521]	$360	405%
Medica Contracted [320239]	$366	412%
Evolutions Health Care Contracted [320124]	$368	414%
First Health Contracted [320128]	$368	414%
Multiplan Contracted [320270]	$368	414%
Private Health Care Systems Contracted [320320]	$368	414%
American Healthcare Alliance Contracted [320020]	$381	429%
Ppo Plus Contracted [320310]	$381	429%
Usa Managed Care Org Contracted [320429]	$381	429%

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 $275.
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 Mercy Hospital Carthage 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.