CMS Price Transparency Data

X-ray, pelvis

Facility: Missouri Baptist Sullivan Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $265
Cash Discount Price: $245
vs. Medicare Baseline: 2.48x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Missouri Baptist Sullivan Hospital is $265. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $245. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.48x the Medicare baseline. Located in 751 Sappington Bridge Rd, Sullivan, MO.

Cash / Self-Pay

$245

Average discount available for prompt cash payment at this facility.

Insurance Median

$265

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: $245 (229%)

Insurance Median: $265 (248%)

Cash: $245 (229% of Medicare)

Ins. Median: $265 (248% 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 248% of the Medicare baseline (a markup of 148%). 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
Blue Cross Blue Shield	$35 - $355	33%
Cigna	$63 - $326	59%
Consociate [478]	$66	62%
Sarah Bush Lincoln [636]	$66	62%
Aetna	$90 - $306	84%
Essence Healthcare [221]	$90	84%
Humana	$91 - $271	85%
UnitedHealthcare	$91 - $449	85%
Cox Health [757]	$94	88%
Medica [662]	$96	90%
Devoted Health Plan [847]	$99	93%
Healthlink [225]	$198 - $308	185%
Cox Health Systems Insurance Company [220]	$224 - $265	210%
Health Alliance [224]	$224	210%
Allied Benefits [498]	$237 - $303	222%
Hope Trust [806]	$237	222%
Coresource [497]	$246	230%
Fmh Benefit Service Inc [222]	$246	230%
Mail Handlers [495]	$246	230%
Healthscope Benefits [258]	$265 - $449	248%
Med-Pay [480]	$265 - $306	248%
Unicare [568]	$265 - $308	248%
Apwu Health Plan [216]	$280	262%
Nalc Health Benefit Plan [242]	$280	262%
Priority Health [648]	$280	262%
First Health Commercial [734]	$303	284%
Beechstreet [551]	$306	286%
Detego Health [868]	$306	286%
Health Systems Inc [620]	$306	286%
Healthcare Sol Mercy [609]	$306	286%
Multiplan Commercial [737]	$306	286%
Multiplan [240]	$306	286%
Phcs [244]	$306 - $326	286%
Preferred Health Professionals [561]	$308	288%
Hfn [563]	$326	305%
Medica [661]	$326	305%

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 $245.
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 Missouri Baptist Sullivan 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.