CMS Price Transparency Data

X-ray, lower back

Facility: Iowa Specialty Hospital - Belmond

Billing Code: 72110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72110
Insurance Median: $104
Cash Discount Price: $168
vs. Medicare Baseline: 0.97x Medicare

The contracted insurance negotiated median rate for a X-ray, lower back at Iowa Specialty Hospital - Belmond is $104. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $168. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.97x the Medicare baseline. Located in 403 First Street Se, Belmond, IA.

Cash / Self-Pay

$168

Average discount available for prompt cash payment at this facility.

Insurance Median

$104

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: $168 (157%)

Insurance Median: $104 (97%)

Cash: $168 (157% of Medicare)

Ins. Median: $104 (97% 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
Aetna	$12 - $460	11%
Tricare	$12 - $155	11%
Triwest Va Choice And Pc3-All Plans	$12 - $155	11%
UnitedHealthcare	$12 - $424	11%
Healthscope Stellar - All Plans	$20 - $256	19%
Wellmark Hmo	$24 - $109	22%
Wellmark Ppo-All Other Plans	$27 - $120	25%
Health Partners Ish-All Other Plans	$28 - $387	26%
Auxiant Clarion Schools-All Plans	$49 - $315	46%
Health Partners Prestage	$56 - $363	52%
Cigna	$99 - $469	93%
Midlands Choice-All Plans	$99 - $469	93%

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 $168.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72110.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Iowa Specialty Hospital - Belmond is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72110.
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.