CMS Price Transparency Data

X-ray, pelvis

Facility: Nicholas H Noyes Memorial Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $17
Cash Discount Price: $158
vs. Medicare Baseline: 0.16x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Nicholas H Noyes Memorial Hospital is $17. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $158. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.16x the Medicare baseline. Located in 111 Clara Barton Street, Dansville, NY.

Cash / Self-Pay

$158

Average discount available for prompt cash payment at this facility.

Insurance Median

$17

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: $158 (148%)

Insurance Median: $17 (16%)

Cash: $158 (148% of Medicare)

Ins. Median: $17 (16% 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	$5 - $28	5%
Blue Cross Blue Shield	$6 - $228	6%
Medicare (plans)	$7 - $183	7%
UnitedHealthcare	$7 - $257	7%
Aetna	$8 - $130	7%
Excellus 2201	$8 - $27	7%
Fidelis 5155	$8 - $27	7%
Mvp 2900	$8 - $301	7%
Independent Health 5156	$10 - $40	9%
Cigna	$11 - $310	10%
Molina Healthcare 1723	$13 - $28	12%
Capital District Physicians Health Plan (Cdphp) 5149	$21 - $69	20%
Humana	$130	122%
Empire Plan 5179	$210	197%
Pomco Ins Co 5157	$278	260%

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 $158.
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 Nicholas H Noyes Memorial 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.