X-ray, pelvis

For the X-ray, pelvis procedure (CPT 72170), the gross charge is $364.00, while the facility's negotiated rate across 51 payers ranges from $16 to $346. This negotiated rate is significantly higher than the cash price of $237.00 and the Medicare benchmark of $106.81. While many commercial payers have negotiated rates between $77 and $102, others, such as UnitedHealthcare and Cigna, have allowed amounts reaching up to $337 and $467 respectively. Patients should be aware that in-network insurance often results in higher out-of-pocket costs than paying cash directly, particularly if their deductible has not yet been met. In this case, the cash price is lower than the median negotiated rate of $102.00, meaning self-pay could save patients money compared to using insurance for this specific service.

To minimize costs, patients should contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% for upfront payment. It is also important to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that can be corrected. This procedure is not subject to balance billing protections under the No Surprises Act for in-network care, but patients should verify that all ancillary services were rendered and that no out-of-network providers were involved. By comparing the facility's rates against the Medicare benchmark and seeking prompt-pay incentives, patients can ensure they are paying