CMS Price Transparency Data

X-ray, pelvis

Facility: Lexington Memorial Hospital Inc

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $377
Cash Discount Price: $427
vs. Medicare Baseline: 3.53x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Lexington Memorial Hospital Inc is $377. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $427. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.53x the Medicare baseline. Located in 250 Hospital Drive Po Box 1817, Lexington, NC.

Cash / Self-Pay

$427

Average discount available for prompt cash payment at this facility.

Insurance Median

$377

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: $427 (400%)

Insurance Median: $377 (353%)

Cash: $427 (400% of Medicare)

Ins. Median: $377 (353% 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 353% of the Medicare baseline (a markup of 253%). 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
Amerihealth	$161 - $234	151%
Carolina Complete	$161	151%
Healthy Blue	$161	151%
Partners	$161	151%
UnitedHealthcare	$162 - $382	152%
Vaya	$162	152%
Wellcare	$162	152%
Alliance	$164	154%
Trillium	$166	155%
Medcost	$187 - $571	175%
Blue Cross Blue Shield	$231 - $370	216%
Aetna	$242 - $788	227%
Ambetter / Centene	$245	229%
Oscar	$273 - $375	256%
Cigna	$371 - $378	347%
Directnet	$504	472%
Healthgram Lexington Home Brands	$614	575%
Healthgram	$682	639%
Private Healthcare Systems	$699	654%
Beechstreet	$751	703%
Humana	$751	703%
Multiplan	$768	719%
National Provider Network	$768	719%

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 $427.
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 Lexington Memorial Hospital Inc 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.