CMS Price Transparency Data

X-ray, pelvis

Facility: Good Samaritan Hospital Medical Center

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 Good Samaritan Hospital Medical Center 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 1000 Montauk Highway, West Islip, 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

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Affinity Health Plan $13 - $28 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%
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 - $321 59%
Daniel H Cook $63 59%
Nalc $63 59%
Samba $63 59%
Blue Cross Blue Shield $65 - $123 61%
Self Pay $85 80%
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 $203 190%
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 $321 301%
American Group Administrators $321 301%
Bakery & Confectionery Union $321 301%
Brighton $321 - $375 301%
Comprehensive Benefits Consultant $321 301%
Guardian Life Insurance Company Of America $321 301%
Maloney And Assoc $321 301%
Multiplan $321 301%
Performax $321 301%
Phcs $321 301%
Pomco $321 301%
Tpa Inc $321 301%
Unicare $321 301%
United Employees Health Plan $321 301%
Coventry $366 - $420 343%
Galaxy $445 417%
Three Rivers Provider Network $445 417%
Aither Health $494 463%
Alpha Care $494 463%
Dentaquest $494 463%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1000 Montauk Highway, West Islip, NY 11795
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals