CMS Price Transparency Data

X-ray, pelvis

Facility: Cheshire Medical Center

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $89
Cash Discount Price: $113
vs. Medicare Baseline: 0.83x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Cheshire Medical Center is $89. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $113. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.83x the Medicare baseline. Located in 580 Court Street, Keene, NH.

Cash / Self-Pay

$113

Average discount available for prompt cash payment at this facility.

Insurance Median

$89

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: $113 (106%)

Insurance Median: $89 (83%)

Cash: $113 (106% of Medicare)

Ins. Median: $89 (83% 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
Aetna	$8 - $482	7%
Ambetter / Centene	$9 - $99	8%
Blue Cross Blue Shield	$9 - $560	8%
Cigna	$9 - $640	8%
Martin'S Point Generations Advantage	$9 - $111	8%
Martin'S Point Health Care	$9 - $111	8%
Mvp	$9 - $640	8%
UnitedHealthcare	$9 - $535	8%
Wellcare Health Plans	$9 - $111	8%
Wellsense Health Plan	$9 - $119	8%
Amerihealth Caritas Nh	$14 - $86	13%
Granite State Health Plan	$16 - $118	15%
Mass General Brigham Health Plan	$23 - $705	22%
Harvard Pilgrim Health Care Of Ne	$25 - $371	23%
Tufts Health Plan	$25 - $450	23%
Maine Community Health Options	$52 - $317	49%
First Health/Hcvm	$99 - $599	93%
Phcs	$104 - $634	97%

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 $113.
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 Cheshire Medical Center 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.