CMS Price Transparency Data

X-ray, neck (cervical spine)

Facility: Highland Hospital

Billing Code: 72040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72040
Insurance Median: $67
Cash Discount Price: $371
vs. Medicare Baseline: 0.75x Medicare

The contracted insurance negotiated median rate for a X-ray, neck (cervical spine) at Highland Hospital is $67. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $371. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 0.75x the Medicare baseline. Located in 1000 South Avenue, Rochester, NY.

Cash / Self-Pay

$371

Average discount available for prompt cash payment at this facility.

Insurance Median

$67

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: $371 (417%)

Insurance Median: $67 (75%)

Cash: $371 (417% of Medicare)

Ins. Median: $67 (75% 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
Amerigroup (Bswny Alternate) [1720]	$15	17%
Excellus [2201]	$15 - $202	17%
Medicaid / KanCare	$15 - $79	17%
Molina Healthcare [5189], Molina Healthcare [1723]	$15	17%
UnitedHealthcare	$15 - $115	17%
Mvp [2900]	$17 - $294	19%
Fidelis [5155]	$33 - $83	37%
Aetna	$37 - $135	42%
Elderplan [1316]	$37	42%
Excellus Bc/Bs [2201]	$37 - $69	42%
Humana	$37 - $133	42%
Icircle [1728]	$37	42%
Martins Point [1205]	$37 - $109	42%
Medicare (plans)	$37 - $144	42%
Nascentia [1729]	$37	42%
Highmark Bc/Bs Of Western Ny [5143]	$39 - $42	44%
Excellus Bc/Bs [2201], Bc/Bs Out Of Area [2401]	$53 - $128	60%
Independent Health [5156]	$53 - $65	60%
Cigna	$88 - $325	99%
Capital District Physicians Health Plan (Cdphp) [5149]	$97 - $130	109%
Blue Cross Blue Shield	$109 - $155	123%

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 $371.
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 Highland 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.