CMS Price Transparency Data

X-ray, pelvis

Facility: Davis County Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72170
  • Insurance Median: $155
  • Cash Discount Price: $282
  • vs. Medicare Baseline: 1.45x Medicare
The contracted insurance negotiated median rate for a X-ray, pelvis at Davis County Hospital is $155. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $282. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.45x the Medicare baseline. Located in 509 North Madison Street, Bloomfield, IA.
Cash / Self-Pay
$282

Average discount available for prompt cash payment at this facility.

Insurance Median
$155

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: $282 (264%)
Insurance Median: $155 (145%)
Cash: $282 (264% of Medicare)
Ins. Median: $155 (145% 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.

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
Blue Cross Blue Shield $66 - $73 62%
Aetna $141 132%
Choicecare Mcr Adv $152 142%
Home State Hlth Exch - All Other Plans $152 142%
Home State Hlth Mcr $152 142%
Mt Carmel Hp-All Plans $152 142%
Tricare $152 142%
Amerigroup Mcr Adv-All Other Plans $155 145%
American Hp Mcr Adv-All Plans $160 150%
Home State Hlth Mcaid $169 158%
Iowa Total Care Mcaid-All Plans $173 162%
Molina Mcaid-All Plans $175 164%
Amerigroup Mcaid $176 165%
Midlands Choice - All Plans $197 184%
Preferred Hlth Choices - All Plans $212 198%
Choicecare Comm - All Other Plans $268 251%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 509 North Madison Street, Bloomfield, IA 52537
  • CMS Rating: No CMS Rating
  • Ownership Type: Government - Local
  • Hospital Type: Critical Access Hospitals