CMS Price Transparency Data

X-ray, lower back

Facility: Ira Davenport Memorial Hospital

Billing Code: 72110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72110
Insurance Median: $536
Cash Discount Price: $483
vs. Medicare Baseline: 5.02x Medicare

The contracted insurance negotiated median rate for a X-ray, lower back at Ira Davenport Memorial Hospital is $536. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $483. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.02x the Medicare baseline. Located in 7571 State Route 54, Bath, NY.

Cash / Self-Pay

$483

Average discount available for prompt cash payment at this facility.

Insurance Median

$536

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: $483 (452%)

Insurance Median: $536 (502%)

Cash: $483 (452% of Medicare)

Ins. Median: $536 (502% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 502% of the Medicare baseline (a markup of 402%). 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
Empire	$10 - $48	9%
Blue Cross Blue Shield	$34 - $2,503	32%
Fidelis	$112	105%
Humana	$126 - $743	118%
Tricare	$126	118%
Amerihealth Caritas Mcr Adv - All Plans	$127	119%
Fidelis Care - Exchange - All Plans	$436 - $454	408%
Geisinger - All Plans	$462 - $480	433%
Cigna	$494 - $514	463%
Mvp Health Plan - All Plans	$494 - $514	463%
Independent Health - All Plans	$516 - $536	483%
Upmc - All Plans	$547 - $569	512%
Pomco Inc - All Plans	$571 - $594	535%
Aetna	$595 - $736	557%
UnitedHealthcare	$595 - $866	557%
Emblem Health - All Plans	$698 - $726	653%
Emblem/Ghi	$733 - $762	686%
Martins Point - All Plans	$793 - $825	742%
Healthnow - All Plans	$2,613 - $2,718	2446%

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 $483.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72110.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Ira Davenport Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72110.
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.