CMS Price Transparency Data

X-ray, pelvis

Facility: Alton Memorial Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $167
Cash Discount Price: $170
vs. Medicare Baseline: 1.56x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Alton Memorial Hospital is $167. 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 1.56x the Medicare baseline. Located in One Memorial Drive, Alton, IL.

Cash / Self-Pay

$170

Average discount available for prompt cash payment at this facility.

Insurance Median

$167

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: $167 (156%)

Cash: $170 (159% of Medicare)

Ins. Median: $167 (156% 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
Blue Cross Blue Shield	$36 - $246	34%
Cigna	$61 - $226	57%
Aetna	$63 - $212	59%
Allied Benefits [498]	$63 - $210	59%
Coresource [497]	$63	59%
Fmh Benefit Service Inc [222]	$63	59%
Mail Handlers [495]	$63	59%
Humana	$64 - $112	60%
Consociate [478]	$66	62%
Sarah Bush Lincoln [636]	$66	62%
Apwu Health Plan [216]	$68	64%
Nalc Health Benefit Plan [242]	$68	64%
Priority Health [648]	$68	64%
UnitedHealthcare	$112 - $296	105%
Essence Healthcare [221]	$115	108%
Cox Health [757]	$118	110%
Devoted Health Plan [847]	$118	110%
Medica [662]	$118	110%
Healthlink [225]	$137 - $214	128%
Cox Health Systems Insurance Company [220]	$156 - $184	146%
Health Alliance [224]	$156	146%
Hope Trust [806]	$164	154%
Med-Pay [480]	$184 - $212	172%
Unicare [568]	$184 - $214	172%
First Health Commercial [734]	$210	197%
Beechstreet [551]	$212	198%
Detego Health [868]	$212	198%
Health Systems Inc [620]	$212	198%
Healthcare Sol Mercy [609]	$212	198%
Multiplan Commercial [737]	$212	198%
Multiplan [240]	$212	198%
Phcs [244]	$212 - $226	198%
Preferred Health Professionals [561]	$214	200%
Hfn [563]	$226	212%
Medica [661]	$226	212%
Healthscope Benefits [258]	$296	277%

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 Alton 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.