CMS Price Transparency Data

X-ray, pelvis

Facility: T J Samson Community Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $22
Cash Discount Price: $83
vs. Medicare Baseline: 0.21x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at T J Samson Community Hospital is $22. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $83. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.21x the Medicare baseline. Located in 1301 North Race Street, Glasgow, KY.

Cash / Self-Pay

$83

Average discount available for prompt cash payment at this facility.

Insurance Median

$22

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: $83 (78%)

Insurance Median: $22 (21%)

Cash: $83 (78% of Medicare)

Ins. Median: $22 (21% 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
Blue Cross Blue Shield	$8 - $199	7%
Center Care Select - All Plans	$8 - $199	7%
Devoted Mcr Adv - All Plans	$8 - $112	7%
Humana	$8 - $106	7%
Molina Mcr Adv	$8 - $108	7%
Signature Health - All Plans	$8 - $107	7%
Wellcare Mcr Adv - All Other Plans	$8 - $106	7%
Caresource - All Plans	$10 - $159	9%
Molina Marketplace - All Other Plans	$10 - $159	9%
Aetna	$21	20%
Wellcare Mcaid	$21 - $104	20%
Molina Mcaid	$22	21%
UnitedHealthcare	$182	170%
Phcs/Multiplan - All Plans	$220	206%
First Health - All Plans	$222	208%

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 $83.
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 T J Samson Community 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.