CMS Price Transparency Data

X-ray, pelvis

Facility: Perham Health

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $102
Cash Discount Price: $184
vs. Medicare Baseline: 0.95x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Perham Health is $102. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $184. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.95x the Medicare baseline. Located in 1000 Coney Street West, Perham, MN.

Cash / Self-Pay

$184

Average discount available for prompt cash payment at this facility.

Insurance Median

$102

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: $184 (172%)

Insurance Median: $102 (95%)

Cash: $184 (172% of Medicare)

Ins. Median: $102 (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
Blue Cross Blue Shield	$79 - $191	74%
Health Partners Mcr Adv	$96	90%
Humana	$96	90%
Medica Mcr Adv	$96	90%
Medicare (plans)	$96 - $107	90%
Ucare Mn Senior Health Options	$96	90%
UnitedHealthcare	$99 - $221	93%
Ucare Mn Special Needs Basic Care Dual	$101	95%
Medicaid / KanCare	$102	95%
Ucare Mn Medical Assistance	$102	95%
Ucare Mn Minnesota Care	$102	95%
Ucare Mn Senior Care Plus	$102	95%
Ucare Mn Special Needs Basic Care	$102	95%
Medica Mcaid Mn Care	$104	97%
Medica Mn (Msho)	$117	110%
Ucare Individual And Family Plan-All Other Plans	$117	110%
Medica Mn Senior Hp/Outside Mn	$129	121%
Health Partners Minnesota Care	$142	133%
Medica Commercial-All Other Plans	$207	194%
Preferred One (Pchp, Pic, Pas)-All Other Plans	$212	198%
Health Partners-All Plans	$232	217%
Preferred One (Ppo)	$241	226%
Sanford Health Plan-All Plans	$241	226%

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 $184.
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 Perham Health 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.