CMS Price Transparency Data

X-ray, pelvis

Facility: Novant Health Medical Park Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $105
Cash Discount Price: $256
vs. Medicare Baseline: 0.98x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Novant Health Medical Park Hospital is $105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $256. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.98x the Medicare baseline. Located in 1950 S Hawthorne Rd, Winston-Salem, NC.

Cash / Self-Pay

$256

Average discount available for prompt cash payment at this facility.

Insurance Median

$105

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: $256 (240%)

Insurance Median: $105 (98%)

Cash: $256 (240% of Medicare)

Ins. Median: $105 (98% 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	$24 - $293	22%
Carolina Complete	$101	95%
Humana	$101 - $333	95%
Nc Department Of Public Safety	$101 - $203	95%
Pace Of The Southern Piedmont	$101	95%
UnitedHealthcare	$101 - $287	95%
Amerihealth	$103	96%
Wellcare	$103	96%
Aetna	$104 - $342	97%
Cigna	$104 - $254	97%
Liberty Health	$106	99%
Caresource North Carolina	$171	160%
Atlantic Corporation Dba Atlantic Packaging	$241	226%
Plotkin Health	$256	240%
Amps	$278	260%
Medcost	$363 - $401	340%
Primary Physician Care	$376	352%
Beechstreet	$384	360%
Multiplan	$384	360%
Phcs	$384	360%
Employers Choice Network	$414	388%
Three Rivers Provider Network	$414	388%

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 $256.
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 Novant Health Medical Park 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.