CMS Price Transparency Data

X-ray, pelvis

Facility: St Lukes Regional Medical Center

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $34
Cash Discount Price: $61
vs. Medicare Baseline: 0.32x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at St Lukes Regional Medical Center is $34. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $61. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.32x the Medicare baseline. Located in 2720 Stone Park Boulevard, Sioux City, IA.

Cash / Self-Pay

$61

Average discount available for prompt cash payment at this facility.

Insurance Median

$34

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: $61 (57%)

Insurance Median: $34 (32%)

Cash: $61 (57% of Medicare)

Ins. Median: $34 (32% 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
Nebraska Total Care	$7 - $83	7%
Aetna	$8 - $260	7%
Amerivantage	$8 - $109	7%
Blue Cross Blue Shield	$8 - $106	7%
Humana	$8 - $109	7%
Molina	$8 - $106	7%
UnitedHealthcare	$8 - $284	7%
Avera Health Plan	$12 - $207	11%
Wellmark Uph Self-Funded	$14 - $48	13%
Cigna	$16 - $200	15%
Health Partners Open Network	$18 - $159	17%
Amerigroup	$94	88%
Iowa Total Care	$94	88%
Medica Exchange Inspire	$164	154%
Medica Exchange Insure	$184	172%

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 $61.
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 Lukes Regional Medical Center 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.