X-ray, pelvis
Facility: Nmc Health
Billing Code: 72170 (CPT)
- CPT Billing Code: 72170
- Insurance Median: $79
- Cash Discount Price: $124
- vs. Medicare Baseline: 0.74x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Bluestem Pace | $25 - $101 | 23% |
| Wppa | $33 - $162 | 31% |
| Aetna | $35 - $242 | 33% |
| Occunet | $36 - $176 | 34% |
| Medincrease Health Plan | $39 - $191 | 37% |
| Samaritan Ministries International | $39 - $191 | 37% |
| Medicaid / KanCare | $40 - $162 | 37% |
| Leading Age | $40 - $162 | 37% |
| Prime Health Services | $45 - $221 | 42% |
| UnitedHealthcare | $54 - $265 | 51% |
| Cigna | $57 - $279 | 53% |
| Blue Cross Blue Shield | $126 | 118% |
Consumer Guidance & Cost Commentary
For the X-ray of the pelvis at Nmc Health in Newton, Kansas, the facility's cash price of $124.00 is significantly lower than the gross charge of $294.00. While the facility's negotiated rates with major payers like UnitedHealthcare and Cigna range from $54 to $279, the cash price offers a substantial alternative for patients with high-deductible plans or those without insurance. It is important to note that commercial insurance rates often include administrative overhead and contract markups, making the cash rate a more transparent baseline. Patients should verify their specific plan's allowed amount, as some commercial contracts may exceed the cash price, though the cash rate remains a strong benchmark for fair pricing.
The facility's cash price of $124.00 is notably higher than the Medicare benchmark of $106.81, which serves as the federal standard for cost-based reimbursement. This difference reflects the facility's location in Newton (Zip 67114) and its status as a voluntary non-profit acute care hospital. While the facility has a perfect rating of 5, consumers should be aware that Medicare rates represent the "true cost" of care without commercial markups. To minimize out-of-pocket expenses, patients are encouraged to request a prompt-pay discount before scheduling, which can reduce the final bill by 20% to 50% if paid in full upfront. Additionally, patients should avoid accepting summary bills and instead demand an itemized audit to ensure no unbundled codes or services not rendered are included in the final charge.