CMS Price Transparency Data

X-ray, pelvis

Facility: Veterans Memorial Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $89
Cash Discount Price: $118
vs. Medicare Baseline: 0.83x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Veterans Memorial Hospital is $89. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $118. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.83x the Medicare baseline. Located in 40 1St Street Se, Waukon, IA.

Cash / Self-Pay

$118

Average discount available for prompt cash payment at this facility.

Insurance Median

$89

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: $118 (110%)

Insurance Median: $89 (83%)

Cash: $118 (110% of Medicare)

Ins. Median: $89 (83% 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
Humana	$7 - $155	7%
Aetna	$8 - $138	7%
Amerigroup Mcr Adv	$8 - $89	7%
Iowa Total Care Exchange	$8 - $89	7%
Molina Mcr Adv	$8 - $89	7%
Quartz Mcr Adv	$8 - $89	7%
Welmark Mcr Adv	$8 - $89	7%
Wellmark Hmo - All Other Plans	$61	57%
Quartz Comm - All Other Plans	$65 - $155	61%
Wellmark Ppo	$67	63%
Iowa Total Care Mcr Adv	$89	83%
Medica Mcr Adv	$89	83%
UnitedHealthcare	$89 - $176	83%
Iowa Total Care Mcaid - All Other Plans	$106 - $207	99%
Molina Mcaid - All Other Plans	$106 - $207	99%
Amerigroup Mcaid - All Other Plans	$107 - $207	100%
Medica Comm - All Other Plans	$277	259%

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 $118.
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 Veterans 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.