CMS Price Transparency Data

X-ray, pelvis

Facility: Good Samaritan Medical Center LLC

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $223
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.09x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Good Samaritan Medical Center LLC is $223. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.09x the Medicare baseline. Located in 200 Exempla Cir, Lafayette, CO.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$223

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%)

Insurance Median: $223 (209%)

Ins. Median: $223 (209% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 209% of the Medicare baseline (a markup of 109%). 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	$68 - $460	64%
Geha	$74 - $297	69%
Preferred One	$74 - $205	69%
Kaiser Perm Hmo	$95 - $216	89%
Aarp	$106	99%
UnitedHealthcare	$106 - $297	99%
Kaiser Snp	$107	100%
Select Health	$107	100%
Kaiser Self Funded	$118 - $216	110%
Kaiser Perm Ppo/Pos	$120 - $223	112%
Allegiance	$128	120%
Cigna	$128 - $513	120%
Blue Cross Blue Shield	$204 - $432	191%
Humana	$215	201%
Denv Hlth Med Plan	$278	260%
Cofinity	$369	345%
First Health Network	$369	345%
Private Hlthcare Sys	$384	360%
Multiplan Inc	$436	408%

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 $X.
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 Good Samaritan Medical Center LLC 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.