X-ray, pelvis
Facility: Holton Community Hospital
Billing Code: 72170 (CPT)
- CPT Billing Code: 72170
- Insurance Median: $200
- Cash Discount Price: $181
- vs. Medicare Baseline: 1.87x 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 |
|---|---|---|
| Blue Cross Blue Shield | $125 | 117% |
| UnitedHealthcare | $128 - $242 | 120% |
| Aetna | $128 - $242 | 120% |
| Humana | $129 | 121% |
| Kansas Superior Select - All Plans | $131 | 123% |
| Preferred Health Professionals | $200 | 187% |
| Preferred Health Freedom | $200 | 187% |
| Preferred Health Fn Select - All Other Plans | $200 | 187% |
| Wppa Providers - All Plans | $229 | 214% |
| Medicaid / KanCare | $242 | 227% |
Consumer Guidance & Cost Commentary
For the X-ray, pelvis procedure at Holton Community Hospital, the cash median price is $181.00, which is lower than the facility's gross charge of $242.00. While the facility is a Critical Access Hospital in Kansas, the data does not provide specific county or state average rates for comparison. However, it is important to note that for patients with high-deductible plans, paying the cash price of $181.00 upfront can sometimes be more cost-effective than relying on insurance, as the negotiated rates paid by insurers range from $125 to $242 depending on the plan. Patients should verify if their specific insurance plan has a deductible that would make the insurance payment higher than the cash price, and they are encouraged to ask the hospital directly about "self-pay" or "prompt-pay" discounts that may further reduce the final amount owed.
The facility's negotiated rates vary significantly across payers, with the lowest allowed amount being $125 from Blue Cross Blue Shield and the highest being $242 from Medicaid/KanCare. When comparing these commercial rates to the Medicare benchmark of $106.81, the facility's gross charge represents a markup of 1.9 times the Medicare rate. This highlights that commercial rates often exceed the true cost baseline established by Medicare due to administrative overhead and contract dynamics. To ensure you are not overcharged, it is advisable to request a full itemized billing statement rather than accepting a summary bill, as detailed audits can reveal errors such as unbundled codes or services not rendered. If you receive a balance bill after an out-of-network encounter, you have the right to dispute it under the