CMS Price Transparency Data

X-ray, pelvis

Facility: Montclair Hospital Medical Center

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72170
  • Insurance Median: $134
  • Cash Discount Price: $133
  • vs. Medicare Baseline: 1.25x Medicare
The contracted insurance negotiated median rate for a X-ray, pelvis at Montclair Hospital Medical Center is $134. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $133. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.25x the Medicare baseline. Located in 5000 San Bernardino Road, Montclair, CA.
Cash / Self-Pay
$133

Average discount available for prompt cash payment at this facility.

Insurance Median
$134

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: $133 (125%)
Insurance Median: $134 (125%)
Cash: $133 (125% of Medicare)
Ins. Median: $134 (125% 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.

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
Blue Shield Of Promise $23 22%
Molina $23 - $134 22%
Traditional Medi-Cal $23 22%
Vantage Care $23 - $134 22%
Health Net Of Ca $25 - $195 23%
Blue Cross Blue Shield $33 31%
Inland Empire Healthplan $33 - $167 31%
Rios $127 119%
Alignment $134 125%
Central Health Plan $134 125%
Choice Physicians Network $134 125%
Citrus Valley Physicians Group $134 125%
Elite Health Plan $134 125%
Emanate Health $134 - $268 125%
Epic Health Plan $134 125%
Inland Empire Foundation For Medical Care $134 125%
Medicare (plans) $134 125%
Renal Payor Solution $134 125%
Tricare $134 125%
Brand New Day $135 - $201 126%
Neighborhood $136 127%
Imperial Health Plan Of Ca $142 133%
Health Net Federal Services Prison (Cdcr) $167 156%
Coventry Workers Compensation $171 160%
Worker Compensation $176 165%
Employer Direct Health Care $187 175%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 5000 San Bernardino Road, Montclair, CA 91763
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals