CMS Price Transparency Data

X-ray, pelvis

Facility: Wilcox Memorial Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $93
Cash Discount Price: $198
vs. Medicare Baseline: 0.87x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Wilcox Memorial Hospital is $93. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $198. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.87x the Medicare baseline. Located in 3-3420 Kuhio Highway, Lihue, HI.

Cash / Self-Pay

$198

Average discount available for prompt cash payment at this facility.

Insurance Median

$93

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: $198 (185%)

Insurance Median: $93 (87%)

Cash: $198 (185% of Medicare)

Ins. Median: $93 (87% 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
Alohacare	$19 - $135	18%
Hmsa	$19 - $135	18%
UnitedHealthcare	$19	18%
Ohana	$20 - $151	19%
Mdx	$29 - $135	27%
Uha	$41	38%
Hwmg/Hmaa	$56	52%
Verdegard	$58	54%
Pac Admin	$61	57%
Devoted	$141	132%
Hcha	$264	247%
Kaiser	$264	247%
Multiplan	$264 - $280	247%

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 $198.
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 Wilcox Memorial 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.