CMS Price Transparency Data

X-ray, pelvis

Facility: Essentia Health Holy Trinity Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $203
Cash Discount Price: $228
vs. Medicare Baseline: 1.90x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Essentia Health Holy Trinity Hospital is $203. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $228. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.90x the Medicare baseline. Located in 115 Second Street West, Box 157, Graceville, MN.

Cash / Self-Pay

$228

Average discount available for prompt cash payment at this facility.

Insurance Median

$203

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: $228 (213%)

Insurance Median: $203 (190%)

Cash: $228 (213% of Medicare)

Ins. Median: $203 (190% 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
Itasca Med Care	$106	99%
Primewest	$106	99%
Healthpartners Care Pmap	$120	112%
Medica Access	$123 - $192	115%
Sanford Healthplan	$132 - $139	124%
Blue Cross Blue Shield	$165 - $268	154%
Blue Plus Pmap Pcc Prime	$169 - $268	158%
Healthpartners	$187 - $205	175%
Advocare/Security Health	$191	179%
Freedom Blue Ppo	$191	179%
Healthpartners Care Msho / Mcr Adv	$191	179%
Imcare Msho Pcc Prime	$191	179%
Imcare Msho Ref Req	$191	179%
Medica Advantage Solutions	$191	179%
Medica Msho/Dual Solutions	$191	179%
Medica Prime Solution Group	$191	179%
Medicare (plans)	$191	179%
Nd Va Administration	$191	179%
Platinum Blue/Vantage Blue	$191	179%
Primewest Msho	$191	179%
Secure Blue Msho	$191	179%
Ubh Cost Plan	$191	179%
Ubh Msho	$191	179%
Ucare Msho	$191	179%
UnitedHealthcare	$191 - $279	179%
Ucare	$203	190%
Cigna	$205	192%
Healthpartners Pcc Prime	$205	192%
Wea	$222 - $237	208%
America'S Ppo	$239	224%
Medica	$256 - $270	240%
Medica Uplan	$256	240%
Wps	$256 - $259	240%
Aetna	$262	245%
Medica Choice	$278	260%

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 $228.
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 Essentia Health Holy Trinity 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.