CMS Price Transparency Data

X-ray, pelvis

Facility: Memorial Community Hospital & Health System

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $131
Cash Discount Price: $210
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Memorial Community Hospital & Health System is $131. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $210. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.23x the Medicare baseline. Located in 810 North 22Nd St, Blair, NE.

Cash / Self-Pay

$210

Average discount available for prompt cash payment at this facility.

Insurance Median

$131

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: $210 (197%)

Insurance Median: $131 (123%)

Cash: $210 (197% of Medicare)

Ins. Median: $131 (123% 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
Medicaid / KanCare	$123 - $131	115%
Ne Total Care Mcaid-All Other Plans	$123	115%
UnitedHealthcare	$123 - $249	115%
Blue Cross Blue Shield	$131 - $252	123%
Tricare	$131	123%
Humana	$132 - $236	124%
Medica Mcr Adv	$139	130%
Medica Comm-All Other Plans	$238	223%
Multiplan (Phcs)-All Plans	$257	241%

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 $210.
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 Memorial Community Hospital & Health System 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.