CMS Price Transparency Data

X-ray, neck (cervical spine)

Facility: Wentworth-Douglass Hospital

Billing Code: 72040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72040
Insurance Median: $103
Cash Discount Price: $427
vs. Medicare Baseline: 1.16x Medicare

The contracted insurance negotiated median rate for a X-ray, neck (cervical spine) at Wentworth-Douglass Hospital is $103. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $427. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 1.16x the Medicare baseline. Located in 789 Central Ave, Dover, NH.

Cash / Self-Pay

$427

Average discount available for prompt cash payment at this facility.

Insurance Median

$103

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: $427 (480%)

Insurance Median: $103 (116%)

Cash: $427 (480% of Medicare)

Ins. Median: $103 (116% 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
Generic Commercial [1009]	$83 - $103	93%
Wellsense Nh [1050]	$83 - $92	93%
Blue Cross Blue Shield	$90 - $588	101%
Martin's Point [160007]	$92	103%
Medicare (plans)	$92	103%
Tricare	$92	103%
UnitedHealthcare	$92 - $551	103%
Humana	$95	107%
Harvard Pilgrim [120001]	$311 - $518	350%
Mgb Health Plan [150001]	$448	504%

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 $427.
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 Wentworth-Douglass 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.