CMS Price Transparency Data

X-ray, neck (cervical spine)

Facility: Clarion Hospital

Billing Code: 72040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72040
Insurance Median: $90
Cash Discount Price: $112
vs. Medicare Baseline: 1.01x Medicare

The contracted insurance negotiated median rate for a X-ray, neck (cervical spine) at Clarion Hospital is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $112. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 1.01x the Medicare baseline. Located in One Hospital Drive, Clarion, PA.

Cash / Self-Pay

$112

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $112 (126%)

Insurance Median: $90 (101%)

Cash: $112 (126% of Medicare)

Ins. Median: $90 (101% 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
Upmc	$21 - $104	24%
Medicaid / KanCare	$26	29%
Amerihealth	$29 - $85	33%
Jefferson Health Plan	$29	33%
Geisinger	$32 - $89	36%
Highmark	$68 - $141	76%
Highmark - Ind.& Managed Care	$68 - $190	76%
Martin'S Point - Usfhp	$70 - $85	79%
Gateway	$74 - $91	83%
Devoted Health Plan	$80 - $90	90%
Workers Comp	$83	93%
Highmark Community Blue	$84	94%
Cigna	$85 - $100	96%
Medicare (plans)	$85	96%
Tricare	$85	96%
UnitedHealthcare	$85	96%
Aetna	$87 - $195	98%
The Health Plan	$90 - $199	101%
Pa Health & Wellness	$91	102%
American Health Plan	$93	105%
Peak Health	$140 - $199	157%
Devon	$150	169%

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 $112.
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 Clarion 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.