CMS Price Transparency Data

X-ray, pelvis

Facility: Portsmouth Regional Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $417
Cash Discount Price: $1,085
vs. Medicare Baseline: 3.90x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Portsmouth Regional Hospital is $417. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,085. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.90x the Medicare baseline. Located in 333 Borthwick Ave, Portsmouth, NH.

Cash / Self-Pay

$1,085

Average discount available for prompt cash payment at this facility.

Insurance Median

$417

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: $1,085 (1016%)

Insurance Median: $417 (390%)

Cash: $1,085 (1016% of Medicare)

Ins. Median: $417 (390% 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 390% of the Medicare baseline (a markup of 290%). 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
Blue Cross Blue Shield	$36 - $481	34%
Amerihealth Caritas	$45	42%
Well Sense Health Plan	$89	83%
United	$279 - $716	261%
Maine Community Health	$339 - $575	317%
Harvard Pilgrim	$387 - $484	362%
Tufts Health Plan	$408 - $621	382%
Aetna	$687	643%
Mvp Health Plan	$760	712%
Corvel	$781	731%
Evernorth	$868	813%
Mutual Of Omaha	$868	813%
Multiplan	$879	823%
Cigna	$894	837%
First Health	$987	924%
Healthcare Value Mgmt	$987	924%
Oxford Health Plans	$1,031	965%

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 $1,085.
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 Portsmouth Regional 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.