CMS Price Transparency Data

X-ray, pelvis

Facility: CHI Health Good Samaritan

Billing Code: 72170 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$120

about 1.1× the $107 Medicare rate · typically $90–$215

modeled estimate · not a bill or quote

What this hospital charges insurers

$121

About the fair price

about $1 over the fair price · 1.1× Medicare

Medicare pays $107 Fair price $120 This hospital $121 Cash price $282 Hospital's list price $462

How we calculate the fair BaseRate →

How this hospital compares to other NE hospitals

Highest price of the 9 NE hospitals we have prices for — worth calling around.

Cheapest $21 Priciest $121

Black dot = this hospital, among the 9 NE hospitals with a price for this procedure. Full list below.

A fair price for a X-ray, pelvis is about $120 (about 1.1× the $107 Medicare rate). CHI Health Good Samaritan charges insurers about $121, or about $282 in cash — about the fair price. Located in Kearney, NE.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

3 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Humana AetnaCignaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$97 - $351	91%
Blue Cross Blue Shieldmajor	$101	95%
Humanamajor	$101	95%
Ambetter (Centene)	$87 - $104	81%
Amerigroup	$87 - $106	81%
Medica	$37 - $360	35%
Molina	$88	82%
+ 9 smaller / regional plans	$101 - $268

Excludes 2 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 282), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 72170.

Insurance Before you use insurance

Call your insurance company to confirm CHI Health Good Samaritan is in-network.
Ask your insurer whether prior approval is required for CPT code 72170.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at CHI Health Good Samaritan

Compare: X-ray, pelvis at other NE hospitals

Insurance negotiated median for the same procedure, sorted lowest first.