CMS Price Transparency Data

X-ray, pelvis

Facility: Central Florida Lake Monroe Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $968
Cash Discount Price: $3,025
vs. Medicare Baseline: 9.06x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Central Florida Lake Monroe Hospital is $968. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,025. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 9.06x the Medicare baseline. Located in 1401 W Seminole Blvd, Sanford, FL.

Cash / Self-Pay

$3,025

Average discount available for prompt cash payment at this facility.

Insurance Median

$968

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: $3,025 (2832%)

Insurance Median: $968 (906%)

Cash: $3,025 (2832% of Medicare)

Ins. Median: $968 (906% 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 906% of the Medicare baseline (a markup of 806%). 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
Freedom Health	$218	204%
Optimum	$218	204%
United	$245 - $1,361	229%
Corvel Corporation	$386	361%
Prime Health	$394	369%
Careworks (Rockport Community)	$406	380%
Simply	$466	436%
Molina Healthcare	$575 - $968	538%
Humana	$605	566%
Evolutions	$696	652%
Avmed	$726 - $1,512	680%
Sunshine State Health Plan	$771	722%
Aetna	$907	849%
Florida Health Care Plan	$1,140	1067%
Plotkin Health	$1,512	1416%
Prime Health Sheriff	$1,512	1416%
Multiplan	$2,268 - $2,571	2123%
Three Rivers Provider Network	$2,268	2123%
Ppo Next	$2,571	2407%
Novanet	$2,722	2548%

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 $3,025.
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 Central Florida Lake Monroe Hospital 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.