CMS Price Transparency Data

X-ray, pelvis

Facility: Audubon County Memorial Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $138
Cash Discount Price: $170
vs. Medicare Baseline: 1.29x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Audubon County Memorial Hospital is $138. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $170. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.29x the Medicare baseline. Located in 515 Pacific Avenue, Audubon, IA.

Cash / Self-Pay

$170

Average discount available for prompt cash payment at this facility.

Insurance Median

$138

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: $170 (159%)

Insurance Median: $138 (129%)

Cash: $170 (159% of Medicare)

Ins. Median: $138 (129% 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
UnitedHealthcare	$102	95%
Wellmark Hmo	$104	97%
Wellmark Ppo - All Other Plans	$114	107%
Aetna	$122 - $153	114%
Tricare	$122	114%
Midlands Choice - All Plans	$167	156%
Molina Mcaid - All Plans	$170	159%
Iowa Total Care Mcaid - All Plans	$172	161%
Amerigroup Mcaid - All Plans	$178	167%

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 $170.
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 Audubon County 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.