X-ray, pelvis
Facility: Decatur Health
Billing Code: 72170 (CPT)
- CPT Billing Code: 72170
- Insurance Median: $281
- Cash Discount Price: $331
- vs. Medicare Baseline: 2.63x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 263% of the Medicare baseline (a markup of 163%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 | $163 | 153% |
| Wppa/Providrs Care- All Plans | $221 | 207% |
| UnitedHealthcare | $224 - $281 | 210% |
| Humana | $227 | 213% |
| Aetna | $331 - $368 | 310% |
| Midlands Choice- All Plans | $331 | 310% |
| Medicaid / KanCare | $372 | 348% |
Consumer Guidance & Cost Commentary
For this X-ray of the pelvis at Decatur Health in Oberlin, Kansas, the cash price is $331.00, which is significantly lower than the facility's gross charge of $368.00. While the facility's negotiated rates with major payers like UnitedHealthcare and Aetna range from $224 to $368, the cash price remains competitive. It is important to note that for patients with high-deductible plans, paying the cash price of $331.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates for some insurers exceed the cash amount. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower the final bill.
When evaluating the cost of this service, it is crucial to compare rates against the Medicare benchmark rather than the facility's inflated chargemaster list. The Medicare amount for this procedure is $106.81, which serves as an objective baseline for fair pricing. Although the data does not provide specific state or county average figures for comparison, the facility's cash rate of $331.00 is approximately 3.1 times the Medicare rate. If you receive a bill that includes balance billing from out-of-network providers, remember that the No Surprises Act protects you from paying the difference between the provider's full charge and your insurance allowed amount for emergency care and non-emergency services at in-network facilities. Always request a detailed, itemized bill to ensure no errors or unbundled codes are present before making any payment.