CMS Price Transparency Data

X-ray, pelvis

Facility: UPMC Horizon

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $275
Cash Discount Price: $431
vs. Medicare Baseline: 2.57x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at UPMC Horizon is $275. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $431. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.57x the Medicare baseline. Located in 110 North Main Street, Greenville, PA.

Cash / Self-Pay

$431

Average discount available for prompt cash payment at this facility.

Insurance Median

$275

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: $431 (404%)

Insurance Median: $275 (257%)

Cash: $431 (404% of Medicare)

Ins. Median: $275 (257% 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 257% of the Medicare baseline (a markup of 157%). 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	$18 - $288	17%
Aetna	$19 - $431	18%
Upmc Health Plan	$19 - $111	18%
Geisinger	$24	22%
Health Partners Plans (Jefferson Health Plan)	$26	24%
Highmark Wholecare (Prev Gateway)	$26 - $360	24%
Amerihealth Caritas	$27 - $109	25%
Pa Health & Wellness	$30 - $109	28%
Blue Cross Blue Shield	$63 - $360	59%
Upmc Work Partners	$67	63%
Cigna	$109 - $288	102%
Intergroup	$467	437%
Coventry/First Health	$475	445%
Health Coalition Partners	$503	471%
Private Health Care Systems	$575	538%
Prime Net	$590	552%
Humana	$611	572%

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 $431.
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 UPMC Horizon 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.