CMS Price Transparency Data

X-ray, pelvis

Facility: Dequincy Memorial Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $101
Cash Discount Price: $106
vs. Medicare Baseline: 0.95x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Dequincy Memorial Hospital is $101. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $106. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.95x the Medicare baseline. Located in 110 West 4Th Street, Dequincy, LA.

Cash / Self-Pay

$106

Average discount available for prompt cash payment at this facility.

Insurance Median

$101

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: $106 (99%)

Insurance Median: $101 (95%)

Cash: $106 (99% of Medicare)

Ins. Median: $101 (95% 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
Cigna	$8 - $152	7%
Aetna	$9 - $101	8%
Humana	$26 - $111	24%
Allegiance Hospice	$64	60%
Ambetter / Centene	$64	60%
Blue Advantage	$64	60%
Mcr Lagniappe	$64	60%
Medicare (plans)	$64	60%
Mutual Of Omaha	$64	60%
Peoples Health	$64	60%
Pro Care Advantage	$64	60%
Tricare	$64	60%
UnitedHealthcare	$64 - $101	60%
Vaccn	$64	60%
Wellcare	$64	60%
Mc Vantage Health Plan	$91 - $99	85%
Gulf South Risk Service	$93	87%
Amerihealth Caritas La	$101	95%
Correct Care	$101	95%
Healthy Blue	$101	95%
Louisiana Health Connect	$101	95%
Medicaid / KanCare	$101 - $152	95%
Self Pay	$106	99%
Work Comp	$137	128%
Aarp Healthcare	$152	142%
Allegiance Home Health Sw	$152	142%
American Health Adv	$152	142%
Amfirst	$152	142%
Attorney	$152	142%
Bankers Life	$152	142%
Care Center Of Dequincy	$152	142%
Commerical	$152	142%
Harbor Hospice	$152	142%
High Hope Care Center	$152	142%
Medi-Share	$152	142%
Ppo Plus Lc	$152	142%
Rural Health Carriers	$152	142%
Tri Parish Rehab	$152	142%
United Teachers Assoc	$152	142%
Blue Cross Blue Shield	$198 - $203	185%

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 $106.
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 Dequincy Memorial 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.