CMS Price Transparency Data

X-ray, pelvis

Facility: Sarah D Culbertson Memorial Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $184
Cash Discount Price: $229
vs. Medicare Baseline: 1.72x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Sarah D Culbertson Memorial Hospital is $184. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $229. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.72x the Medicare baseline. Located in 238 South Congress Street, Rushville, IL.

Cash / Self-Pay

$229

Average discount available for prompt cash payment at this facility.

Insurance Median

$184

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: $229 (214%)

Insurance Median: $184 (172%)

Cash: $229 (214% of Medicare)

Ins. Median: $184 (172% 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	$8 - $384	7%
Blue Cross Blue Shield	$8 - $418	7%
Molina Mmai-All Other Plans	$8 - $184	7%
UnitedHealthcare	$8 - $384	7%
Cigna	$10 - $316	9%
Multiplan/Phcs-All Plans	$25 - $384	23%
Meridian Hp Mcaid-All Plans	$40 - $183	37%
Molina Healthcare Mcaid	$40 - $183	37%
Health Dynamics-All Plans	$66 - $384	62%
Preferred Medical Claims Solution-All Plans	$74 - $384	69%
Three Rivers Provider Network-All Plans	$74 - $384	69%
Corvel-All Plans	$183	171%
Humana	$184	172%
Beech Street-All Plans	$384	360%
Encompass-All Plans	$384	360%
Healthlink-All Plans	$384	360%
Hfn Epo	$384	360%
Hfn Ppo Ip/Op Only-All Other Plans	$384	360%
Wexford Ip/Op Only-All Plans	$384	360%
Healthsmart-All Plans	$406	380%

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 $229.
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 Sarah D Culbertson 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.