CMS Price Transparency Data

X-ray, pelvis

Facility: Hermann Area District Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $218
Cash Discount Price: $226
vs. Medicare Baseline: 2.04x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Hermann Area District Hospital is $218. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $226. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.04x the Medicare baseline. Located in 509 W 18Th St, Hermann, MO.

Cash / Self-Pay

$226

Average discount available for prompt cash payment at this facility.

Insurance Median

$218

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: $226 (212%)

Insurance Median: $218 (204%)

Cash: $226 (212% of Medicare)

Ins. Median: $218 (204% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 204% of the Medicare baseline (a markup of 104%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Healthy Blue Mcaid - All Plans	$19	18%
Ambetter / Centene	$20 - $265	19%
Blue Cross Blue Shield	$21 - $306	20%
UnitedHealthcare	$21 - $292	20%
Tricare	$149	140%
Choicecare Mcr Adv- All Plans	$158	148%
American Hlth Mcr Adv- All Plans	$165	154%
Humana	$165	154%
Aetna	$169 - $357	158%
Wellcare Mcr Adv - All Plans	$169	158%
Cigna	$205	192%
Harmony Hp Mcaid- All Plans	$218	204%
Care Partners Mcaid- All Plans	$226	212%
Healthcare Usa Mcaid- All Plans	$244	228%
Healthlink Hmo	$244	228%
Healthlink Ppo - All Other Plans	$282	264%
Multiplan/Phcs - All Plans	$282	264%
Coventry - All Plans	$320	300%
Comp Results - All Plans	$338	316%
Three Rivers - All Plans	$338	316%

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 $226.
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 Hermann Area District 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.