CMS Price Transparency Data

X-ray, neck (cervical spine)

Facility: UPMC Kane

Billing Code: 72040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72040
Insurance Median: $78
Cash Discount Price: $80
vs. Medicare Baseline: 0.88x Medicare

The contracted insurance negotiated median rate for a X-ray, neck (cervical spine) at UPMC Kane is $78. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $80. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 0.88x the Medicare baseline. Located in 4372 Route 6, Kane, PA.

Cash / Self-Pay

$80

Average discount available for prompt cash payment at this facility.

Insurance Median

$78

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: $80 (90%)

Insurance Median: $78 (88%)

Cash: $80 (90% of Medicare)

Ins. Median: $78 (88% 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 Health Plan	$19 - $97	21%
Blue Cross Blue Shield	$20 - $145	22%
Aetna	$21 - $81	24%
UnitedHealthcare	$21 - $103	24%
Highmark Wholecare (Prev Gateway)	$21 - $80	24%
Amerihealth Caritas	$22 - $84	25%
Geisinger	$37	42%
Horizon Health Plan	$38 - $148	43%
Cigna	$38 - $4,750	43%
Multiplan	$41 - $158	46%
Intergroup	$44 - $169	49%
Health Coalition Partners	$44 - $169	49%
PA Health & Wellness	$45	51%
Focus Healthcare	$52 - $200	58%
UPMC Work Partners	$79	89%

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 $80.
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 UPMC Kane 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.