CMS Price Transparency Data

X-ray, pelvis

Facility: Good Samaritan Medical Center

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $132
Cash Discount Price: $162
vs. Medicare Baseline: 1.24x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Good Samaritan Medical Center is $132. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $162. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.24x the Medicare baseline. Located in 235 North Pearl Street, Brockton, MA.

Cash / Self-Pay

$162

Average discount available for prompt cash payment at this facility.

Insurance Median

$132

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: $162 (152%)

Insurance Median: $132 (124%)

Cash: $162 (152% of Medicare)

Ins. Median: $132 (124% 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
Unicare [8004]	$63	59%
Wellpoint [2034]	$63	59%
Aetna	$69 - $125	65%
Meritain Health [1023]	$69	65%
Blue Cross Blue Shield	$125 - $161	117%
Humana	$125	117%
Medicare (plans)	$125 - $132	117%
Neighborhood Pace [1206]	$125	117%
Ubh Hphc [8016]	$125	117%
United Community Plan [1202]	$125	117%
UnitedHealthcare	$125	117%
Veterans Admin [9003]	$125	117%
Zzzcovid19 Hrsa Uninsured Testing And Treatment Fund [500010]	$125	117%
Cca [1215]	$132	124%
Zzzcca Onecare [1216]	$132	124%
Eternalhealth [1227]	$133	125%
Fallon [8008]	$163	153%
Senior Whole Health [1210]	$188	176%
Harvard Pilgrim Health Care [8001]	$196	184%
Mass General Brigham Health Plan Commercial [8009]	$208	195%
Mass General Brigham Health Plan Prime [7003]	$208	195%
Cigna	$215 - $373	201%
Tufts [8002]	$318 - $373	298%
Hsn Bad Debt [4003]	$395	370%
Hsn Confidential [4007]	$395	370%
Hsn Dental [4006]	$395	370%
Hsn Partial [4002]	$395	370%
Hsn [4001]	$395	370%

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 $162.
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 Good Samaritan Medical Center 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.