CMS Price Transparency Data

X-ray, pelvis

Facility: Hospital for Special Surgery

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $270
Cash Discount Price: $292
vs. Medicare Baseline: 2.53x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Hospital for Special Surgery is $270. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $292. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.53x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$292

Average discount available for prompt cash payment at this facility.

Insurance Median

$270

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: $292 (273%)

Insurance Median: $270 (253%)

Cash: $292 (273% of Medicare)

Ins. Median: $270 (253% 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 253% of the Medicare baseline (a markup of 153%). 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
UnitedHealthcare	$6 - $359	6%
Fidelis	$7	7%
Emblem	$9 - $12	8%
Metro Plus	$9	8%
Blue Cross Blue Shield	$12 - $514	11%
Horizon	$14	13%
Nyship	$15	14%
Cigna	$19 - $307	18%
Aetna	$21 - $238	20%
Fidelis Essential [1323]	$28	26%
Christian Brothers [1034]	$214 - $238	200%
Meritain Health [1085]	$214 - $238	200%
Nippon Life [1092]	$214 - $238	200%
Webtpa [1356]	$214 - $238	200%
Oxford [1096]	$233 - $301	218%
Emblem Health [1043]	$234 - $263	219%
Student Resources [1103]	$234 - $302	219%
Connecticare [1039]	$263 - $359	246%
Harvard Pilgrim [1057]	$270 - $348	253%
Apwu [1016]	$276 - $307	258%
Nalc [1090]	$276 - $307	258%
Qualcare [1101]	$276 - $307	258%
Wellfleet [1361]	$276 - $307	258%
Geha [1053]	$302	283%
Affinity By Molina Health Plan [1005]	$345 - $359	323%
Medicare (plans)	$359	336%

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 $292.
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 Hospital for Special Surgery 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.