In the 20 years that Claudia Mattingly was a dependent, she utilized her medical benefits at Madigan Army Medical Center.

"I had no problems with military health care," she said. But she allows that had she known then what she knows now about civilian medical care, given that she works for a civilian health care provider, she might have utilized civilian services.

Primarily, she cites reasons like convenience and consistency in care as things she might have appreciated about health care since with a civilian general practitioner you're more likely to see a single doctor through the entire course of your care.

But there are other considerations for service members and their families to make. Financial burden may be the primary matter.  Still, in light of military health care residing on the front burner in recent weeks as some military personnel have complained their disability ratings were too low or that their diagnoses remained stalled for months on end, The Ranger decided to see just how a soldier would find a second opinion on the outside.

How much does civilian care cost if insurance isn't covering services?

The Ranger conducted an informal experiment to try to ascertain the costs for care of a hypothetical back injury, calling locally and checking on the Internet for information.

Naturally, there is a wide range of costs depending on the type of service.

Chiropractic care, which is recommended as preventative care before the onset of severe pain, is one medical route to take.

 An initial visit can cost $125, which includes X-rays. Additional adjustments can get costly at about $40 per visit, especially if multiple weekly visits are required to reach optimal health.

Often chiropractic care is used in conjunction with massage therapy. Massage from a licensed massage practitioner can range from $40 to $60 per hour, sometimes going higher depending on the therapist and type of massage. Deep tissue work, for example, tends to range on the higher side.

Another alternative pain relief therapy - acupuncture - can be effective for pain relief, but at a cost of about $80 for initial consultation and $55 for a typical visit. And this does not include the cost of herbs that also can help with pain relief.

For traditional medical help, cost of care has multiple variables that made getting straight answers on cost hard to ascertain.  For instance, if a patient is paying cash at the time of service, costs were often reduced, taking into account the lack of billing and processing staff that would be necessary. For more expensive services, many practices will employ staff to help explain costs and set up payment plans to ease access of service for patients.

While a standard doctor's visit to a general practitioner might cost $110, cash at time of service can bring the cost down to around $50 for some providers.

In the case of one medical group based out of Renton, called Simple Care (www.simplecare.com), the entire fee structure is based on cash-only.

Cash-only strategies can apply to imaging services as well.  Since one of the primary tools in assessment of injuries is film, health care costs can rise dramatically based on the type of imaging needed.

X-rays, the least expensive films, might run less than $100 for a whole spine.  Adding a Computed Tomography, or CT, scan to that might run an additional $700 if contrast is used.  Magnetic Resonance Imaging, or MRI, is the most expensive of the imaging services and might run between $700 to $1,500 depending on the part of the spine or series of images needed. Again, cash discounts can apply depending on the practice, and the prices can increase if films are taken in a hospital rather than a private outpatient imaging practice.

If, within the general practice environment, the problem is seen as outside the scope of the practitioner's area of expertise, a specialist might be recommended, and from there, surgery might be the appropriate step.

While no specialists contacted would speak about pricing, it's a safe assumption that the costs of specialty care are more expensive than general practice.  Additionally, with specialists, often more expensive services are advised, such as hospitalization.

Through the Washington State Hospitals Association Web site (www.wsha.org) comparative hospital pricing is available to the general public through the "Hospital Transparency" portal on the site.

From this site, it was ascertained that a nonsurgical back and neck pain hospitalization of about four days would cost $20,618.  Add surgery with no complications and the average stay is reduced to about one day, and the cost becomes $17,707.  With complications, again the stay increases, to about three days, and the cost goes up to $30,062. 

These prices don't include imaging or practitioner costs; things such as anesthesiology, surgeon's time, radiologists' time, and imaging can increase these costs exponentially.

But ultimately, the matter rests on perspective.

"We need to be realistic about health care," Mattingly said.

"For the average person it is expensive."

Feel better?