CMS Price Transparency Data

X-ray, pelvis

Facility: M Health Fairview Ridges Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $71
Cash Discount Price: $154
vs. Medicare Baseline: 0.66x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at M Health Fairview Ridges Hospital is $71. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $154. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.66x the Medicare baseline. Located in 201 East Nicollet Boulevard, Burnsville, MN.

Cash / Self-Pay

$154

Average discount available for prompt cash payment at this facility.

Insurance Median

$71

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: $154 (144%)

Insurance Median: $71 (66%)

Cash: $154 (144% of Medicare)

Ins. Median: $71 (66% 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	$6 - $174	6%
Health Partners	$6 - $319	6%
Hennepin Health	$6 - $108	6%
Itasca Medical Care	$6 - $103	6%
Medica	$6 - $110	6%
Primewest	$6 - $103	6%
South Country Health Alliance	$6 - $103	6%
Ucare	$6 - $238	6%
Sanford Health Plan	$8 - $213	7%
Security Health Plan	$8 - $272	7%
UnitedHealthcare	$8 - $188	7%
Wellcare	$8 - $103	7%
America'S Ppo	$188 - $261	176%
First Health	$296 - $297	277%
Multiplan	$307 - $308	287%
Private Healthcare Systems	$307 - $308	287%
Wisconsin Physician Services	$325 - $326	304%

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 $154.
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 M Health Fairview Ridges 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.