CMS Price Transparency Data

X-ray, pelvis

Facility: Tristar Summit Medical Center

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $155
Cash Discount Price: $2,143
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Tristar Summit Medical Center is $155. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,143. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.45x the Medicare baseline. Located in 5655 Frist Blvd, Hermitage, TN.

Cash / Self-Pay

$2,143

Average discount available for prompt cash payment at this facility.

Insurance Median

$155

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: $2,143 (2006%)

Insurance Median: $155 (145%)

Cash: $2,143 (2006% of Medicare)

Ins. Median: $155 (145% 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
Blue Cross Blue Shield	$18 - $40	17%
Humana	$33 - $1,393	31%
Aetna	$37 - $1,071	35%
Cigna	$63 - $1,714	59%
United	$155 - $964	145%
Kentucky Labor Cabinet	$394	369%
Apex Health	$407	381%
Nhc Advantage, Inc.	$407	381%
Pruitt Health (Allyalign)	$407	381%
Centurion	$883	827%
Bgfh Singlesource	$1,071 - $1,821	1003%
Multiplan	$1,393	1304%
Employers Health Network	$1,500	1404%
Odom'S Tn Pride Sausage	$1,607	1505%
Compsych	$1,714	1605%
Beech Street	$1,886	1766%
Prime Health	$1,886	1766%

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 $2,143.
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 Tristar Summit Medical Center 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.