CMS Price Transparency Data
X-ray, pelvis
Facility: San Gabriel Valley Medical Center
Billing Code: 72170 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 72170
- Insurance Median: $152
- Cash Discount Price: $152
- vs. Medicare Baseline: 1.42x Medicare
The contracted insurance negotiated median rate for a X-ray, pelvis at San Gabriel Valley Medical Center is $152. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $152. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.42x the Medicare baseline. Located in 438 W Las Tunas Drive, San Gabriel, CA.
Cash / Self-Pay
$152
Average discount available for prompt cash payment at this facility.
Insurance Median
$152
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: $152 (142%)
Insurance Median: $152 (142%)
Cash: $152 (142% of Medicare)
Ins. Median: $152 (142% 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.
Out-of-Pocket Cost Estimator
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $7 - $576 | 7% |
| Ahmc Medi-Cal Reciprocity | $22 | 21% |
| Allied Physicians | $22 - $202 | 21% |
| Altamed Health Network | $22 - $132 | 21% |
| Beverly Hospital | $22 - $148 | 21% |
| Brand New Day | $22 - $178 | 21% |
| Emanate Health | $22 - $168 | 21% |
| Healthnet Medi-Cal Non-Contract | $22 | 21% |
| Non Contracting Medi Cal | $22 | 21% |
| La Care Health Plan | $25 - $134 | 23% |
| Aetna | $27 - $195 | 25% |
| Care 1St Health Plan | $30 - $330 | 28% |
| Aids Healthcare Foundation | $31 - $203 | 29% |
| Avanti | $31 - $161 | 29% |
| Healthy Way La | $31 | 29% |
| Hollywood Presbyterian Adv Med Mcal | $31 | 29% |
| Hollywood Presbyterian Medpoint Mcal | $31 | 29% |
| Medicaid / KanCare | $31 | 29% |
| Physicians Healthways | $31 - $134 | 29% |
| Private Pay | $44 | 41% |
| Veterans Administration | $94 | 88% |
| Alignment Health Plan | $132 | 124% |
| Apa/Aco Inc | $132 | 124% |
| Blue Shield Of California | $132 - $219 | 124% |
| Central Health Plan | $132 - $305 | 124% |
| Health Net | $132 - $377 | 124% |
| Health Net Inc | $132 - $314 | 124% |
| Humana | $132 | 124% |
| Medicare (plans) | $132 - $139 | 124% |
| Molina Healthcare Of California | $132 - $198 | 124% |
| Pacific Alliance Medical Center | $132 | 124% |
| Pacificare Of California | $132 - $166 | 124% |
| Providence Health Network | $132 | 124% |
| Tricare | $132 | 124% |
| Wellcare | $132 | 124% |
| Cv-19 Hrsa Uninsured Testing And Tx | $134 | 125% |
| Inter Valley Health Plan | $134 | 125% |
| Self-Pay | $134 | 125% |
| St Vincent Medical Center/Psych | $134 | 125% |
| Ahmc Reciprocity | $152 | 142% |
| Chinatown Service Center Pace | $159 | 149% |
| Ahmc Health Self-Insurance Epo | $168 | 157% |
| Knox-Keene Act | $168 | 157% |
| Alignment Healthplan | $178 | 167% |
| Clever Care | $178 | 167% |
| UnitedHealthcare | $178 - $445 | 167% |
| Athens Administrators | $179 | 168% |
| Beech Street | $179 - $406 | 168% |
| Other Non Contracting Workers Comp | $179 | 168% |
| Pacific Independent Physician Associates | $203 | 190% |
| Cigna | $241 | 226% |
| Facey Medical | $254 | 238% |
| Community Care Network | $330 | 309% |
| Choicecare Network | $356 | 333% |
| Private Healthcare Systems (Phcs) | $356 | 333% |
| Affiliated Health Fund | $381 | 357% |
| Multiplan | $457 | 428% |
| Ppo Next | $457 | 428% |
| Managed Health Network | $508 | 476% |
| Medi-Cal Sub Acute | $508 | 476% |
| One Legacy | $508 | 476% |
| Other Non Contracted Commercial | $508 | 476% |
| Us Behavioral Health Plan | $508 | 476% |