CMS Price Transparency Data
X-ray, pelvis
Facility: St Charles Hospital
Billing Code: 72170 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 72170
- Insurance Median: $126
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.18x Medicare
The contracted insurance negotiated median rate for a X-ray, pelvis at St Charles Hospital is $126. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.18x the Medicare baseline. Located in 200 Belle Terre Road, Port Jefferson, NY.
Cash / Self-Pay
Unavailable
Average discount available for prompt cash payment at this facility.
Insurance Median
$126
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%)
Insurance Median: $126 (118%)
Ins. Median: $126 (118% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Affinity Health Plan | $13 - $28 | 12% |
| Beacon Health Options | $13 - $176 | 12% |
| Beacon Health Strategies | $13 - $176 | 12% |
| Centerlight Healthcare | $13 - $126 | 12% |
| Elderplan Inc. | $13 - $126 | 12% |
| Emblem Health | $13 - $283 | 12% |
| Fidelis Care New York | $13 - $126 | 12% |
| Health First | $13 - $283 | 12% |
| Health Plus | $13 - $126 | 12% |
| Independent Health | $13 - $126 | 12% |
| Medicaid / KanCare | $13 | 12% |
| Mvp Health Plans | $13 - $126 | 12% |
| Senior Whole Health | $13 - $126 | 12% |
| UnitedHealthcare | $13 - $245 | 12% |
| Aetna | $48 - $126 | 45% |
| Self Pay | $50 | 47% |
| Zadroga | $50 | 47% |
| Mail Handlers Benefit Plan | $57 | 53% |
| Meritain Health | $57 | 53% |
| Nippon Life Insurance Company Of America | $57 | 53% |
| Salvation Army | $57 | 53% |
| Apwu | $63 | 59% |
| Centivo | $63 - $82 | 59% |
| Cigna | $63 - $309 | 59% |
| Daniel H Cook | $63 | 59% |
| Nalc | $63 | 59% |
| Samba | $63 | 59% |
| Blue Cross Blue Shield | $65 - $126 | 61% |
| Local 1199 | $108 | 101% |
| Centers Plan For Healthy Living | $126 | 118% |
| Healthspring | $126 | 118% |
| Liberty Health | $126 | 118% |
| Longevity Health Plan | $126 | 118% |
| Medicare (plans) | $126 - $132 | 118% |
| Orthonet - Uniformed Services Family Health Plan | $126 | 118% |
| Pmc | $126 | 118% |
| Tricare | $126 | 118% |
| Universal Healthcare | $126 | 118% |
| Us Family Health Plan | $126 | 118% |
| Veterans Affairs | $126 | 118% |
| Humana | $128 | 120% |
| Agewell New York | $130 | 122% |
| Partners Health Plan | $132 | 124% |
| Wellcare Health Plan Inc | $138 | 129% |
| Oscar Health | $195 | 183% |
| Brighton | $238 - $332 | 223% |
| Surest | $245 | 229% |
| American Plan Administrators | $283 | 265% |
| Amerihealth Administrators | $283 | 265% |
| Benefit Services | $283 | 265% |
| Ghi Cbp Ny City Employee Alternate | $283 | 265% |
| International Benefit Administrator | $283 | 265% |
| Ultra Benefits Inc. | $283 | 265% |
| Allied Wellfare Fund | $309 | 289% |
| American Group Administrators | $309 | 289% |
| Bakery & Confectionery Union | $309 | 289% |
| Comprehensive Benefits Consultant | $309 | 289% |
| Guardian Life Insurance Company Of America | $309 | 289% |
| Maloney And Assoc | $309 | 289% |
| Multiplan | $309 | 289% |
| Performax | $309 | 289% |
| Phcs | $309 | 289% |
| Pomco | $309 | 289% |
| Tpa Inc | $309 | 289% |
| Unicare | $309 | 289% |
| United Employees Health Plan | $309 | 289% |
| Coventry | $352 - $404 | 330% |
| Magellan | $380 | 356% |
| Galaxy | $428 | 401% |
| Three Rivers Provider Network | $428 | 401% |
| Aither Health | $475 | 445% |
| Alpha Care | $475 | 445% |
| Dentaquest | $475 | 445% |