CMS Price Transparency Data

X-ray, pelvis

Facility: St Marys Good Samaritan Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $61
Cash Discount Price: $148
vs. Medicare Baseline: 0.57x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at St Marys Good Samaritan Hospital is $61. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $148. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.57x the Medicare baseline. Located in 5401 Lake Oconee Parkway, Greensboro, GA.

Cash / Self-Pay

$148

Average discount available for prompt cash payment at this facility.

Insurance Median

$61

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: $148 (139%)

Insurance Median: $61 (57%)

Cash: $148 (139% of Medicare)

Ins. Median: $61 (57% 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
Peach State	$26	24%
Wellcare	$26 - $61	24%
Blue Cross Blue Shield	$44 - $164	41%
Aetna	$61 - $182	57%
Ambetter / Centene	$61	57%
Care Improvement Plus	$61	57%
Caresource	$61	57%
Cigna	$61 - $186	57%
Coventry	$61 - $170	57%
Eon Health Plan	$61	57%
Humana	$61 - $170	57%
Kaiser Permanente	$61	57%
Molina	$61	57%
Pruitthealth Premier	$61	57%
Todays Options Pffs	$61	57%
Todays Options Ppo	$61	57%
UnitedHealthcare	$61 - $2,632	57%
Vaccn United	$61	57%
First Health	$170	159%
Phcs	$170	159%
Meritain	$182	170%
Multiplan	$193 - $197	181%
Nova	$193 - $204	181%
Three Rivers Provider Network	$204	191%
Amerigroup	$227	213%

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 $148.
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 St Marys Good Samaritan 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.