CMS Price Transparency Data

X-ray, pelvis

Facility: Highland Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $48
Cash Discount Price: $502
vs. Medicare Baseline: 0.45x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Highland Hospital is $48. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $502. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.45x the Medicare baseline. Located in 1000 South Avenue, Rochester, NY.

Cash / Self-Pay

$502

Average discount available for prompt cash payment at this facility.

Insurance Median

$48

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: $502 (470%)

Insurance Median: $48 (45%)

Cash: $502 (470% of Medicare)

Ins. Median: $48 (45% 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
Amerigroup (Bswny Alternate) [1720]	$13	12%
Excellus [2201]	$13 - $244	12%
Medicaid / KanCare	$13 - $56	12%
Molina Healthcare [5189], Molina Healthcare [1723]	$13	12%
UnitedHealthcare	$13 - $138	12%
Mvp [2900]	$14 - $355	13%
Aetna	$26 - $164	24%
Elderplan [1316]	$26	24%
Excellus Bc/Bs [2201]	$26 - $48	24%
Humana	$26 - $161	24%
Icircle [1728]	$26	24%
Martins Point [1205]	$26 - $130	24%
Medicare (plans)	$26 - $174	24%
Nascentia [1729]	$26	24%
Fidelis [5155]	$28 - $58	26%
Highmark Bc/Bs Of Western Ny [5143]	$32 - $34	30%
Excellus Bc/Bs [2201], Bc/Bs Out Of Area [2401]	$37 - $90	35%
Independent Health [5156]	$43 - $52	40%
Cigna	$62 - $393	58%
Capital District Physicians Health Plan (Cdphp) [5149]	$69 - $92	65%
Blue Cross Blue Shield	$130 - $186	122%

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 $502.
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 Highland 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.