CMS Price Transparency Data

X-ray, pelvis

Facility: Memorial Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $90
Cash Discount Price: $283
vs. Medicare Baseline: 0.84x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Memorial Hospital is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $283. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.84x the Medicare baseline. Located in 715 South Taft Avenue, Fremont, OH.

Cash / Self-Pay

$283

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $283 (265%)

Insurance Median: $90 (84%)

Cash: $283 (265% of Medicare)

Ins. Median: $90 (84% 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
Aetna	$24 - $492	22%
Summacare	$24 - $273	22%
Paramount Healthcare Inc	$25 - $244	23%
Blue Cross Blue Shield	$26 - $520	24%
Buckeye Community Health Plan	$26 - $295	24%
Caresource	$26 - $187	24%
Frontpath	$26 - $266	24%
Health Alliance Plan	$26 - $308	24%
Humana	$26 - $400	24%
Molina Healthcare Of Ohio	$26 - $615	24%
UnitedHealthcare	$28 - $344	26%
Cigna	$29 - $304	27%
Health Ohio Network	$36 - $301	34%
Amerihealth	$42 - $67	39%
Meridian Health Plan Of Mi	$57 - $400	53%
Medical Mutual Of Ohio	$83 - $291	78%
Multiplan	$83 - $392	78%

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 $283.
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 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.