CMS Price Transparency Data

X-ray, pelvis

Facility: Adventist Health Ukiah Valley

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $46
Cash Discount Price: $11
vs. Medicare Baseline: 0.43x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Adventist Health Ukiah Valley is $46. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $11. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.43x the Medicare baseline. Located in 275 Hospital Drive, Ukiah, CA.

Cash / Self-Pay

$11

Average discount available for prompt cash payment at this facility.

Insurance Median

$46

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: $11 (10%)

Insurance Median: $46 (43%)

Cash: $11 (10% of Medicare)

Ins. Median: $46 (43% 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

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
Ah Employee Health Plan - All Plans	$9 - $259	8%
Blue Shield Mcr Adv	$9 - $144	8%
Kaiser Mcr Adv	$9 - $144	8%
Tricare	$9 - $144	8%
Cigna	$11 - $722	10%
UnitedHealthcare	$11 - $774	10%
Blue Shield Epn-All Other Plans	$12 - $353	11%
Healthnet-All Plans	$12 - $530	11%
Blue Shield Non-Epn	$13 - $357	12%
Western Growers-All Plans	$13 - $389	12%
Aetna	$16 - $123	15%
Mendocino Lcc District-All Plans	$21 - $602	20%
Kaiser Medi-Cal	$22 - $31	21%
Medi-Cal	$22 - $31	21%
Kaiser-All Other Plans	$26 - $741	24%
Three Rivers-All Plans	$30 - $833	28%
Foundation For Medical Care-All Plans	$41 - $694	38%
Networks By Design-All Plans	$44 - $741	41%
Phcs Multiplan-All Plans	$44 - $741	41%
Interplan-All Plans	$45 - $759	42%
Beech Street-All Plans	$47 - $787	44%
Choice Care-All Plans	$47 - $787	44%
Health Mgmt Network-All Plans	$47 - $787	44%
Blue Cross Blue Shield	$151 - $201	141%

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 $11.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72170.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health Ukiah Valley is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72170.
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.