CMS Price Transparency Data

X-ray, neck (cervical spine)

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 72040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72040
Insurance Median: $368
Cash Discount Price: $470
vs. Medicare Baseline: 4.14x Medicare

The contracted insurance negotiated median rate for a X-ray, neck (cervical spine) at UPMC Children's Hospital of Pittsburgh is $368. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $470. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 4.14x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$470

Average discount available for prompt cash payment at this facility.

Insurance Median

$368

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: $470 (529%)

Insurance Median: $368 (414%)

Cash: $470 (529% of Medicare)

Ins. Median: $368 (414% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 414% of the Medicare baseline (a markup of 314%). 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
Aetna	$38 - $431	43%
Upmc Health Plan	$61 - $164	69%
UnitedHealthcare	$66 - $368	74%
Health Plan Of Upper Ohio Valley	$84 - $509	94%
Blue Cross Blue Shield	$89 - $392	100%
Amerihealth Caritas	$91 - $99	102%
Cigna	$91 - $431	102%
Health Partners Plans (Jefferson Health Plan)	$103	116%
Highmark Wholecare (Prev Gateway)	$107	120%
Pa Health & Wellness	$107	120%
Geisinger	$109 - $352	123%
Intergroup	$509 - $666	572%
Coventry/First Health	$626	704%
Saudi Armed Forces	$626	704%
Health Payors Organization	$666	749%
Multiplan	$666	749%
National Provider Network	$705	793%
Private Health Care Systems	$705	793%

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 $470.
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 Children's Hospital of Pittsburgh 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.