CMS Price Transparency Data

X-ray, pelvis

Facility: St Luke's Sugar Land Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $164
Cash Discount Price: $457
vs. Medicare Baseline: 1.54x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at St Luke's Sugar Land Hospital is $164. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $457. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.54x the Medicare baseline. Located in 1317 Lake Pointe Parkway, Sugar Land, TX.

Cash / Self-Pay

$457

Average discount available for prompt cash payment at this facility.

Insurance Median

$164

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: $457 (428%)

Insurance Median: $164 (154%)

Cash: $457 (428% of Medicare)

Ins. Median: $164 (154% 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
Wellpoint	$28 - $160	26%
Blue Cross Blue Shield	$29 - $378	27%
United	$29 - $614	27%
UnitedHealthcare	$29 - $1,080	27%
Chc	$32 - $719	30%
Cigna	$61 - $915	57%
Renaissance	$77	72%
Tchp	$105 - $140	98%
Humana	$107 - $850	100%
Selectcare	$107	100%
Aetna	$109 - $889	102%
Amerivantage	$110	103%
Kelsey	$113	106%
Devoted	$114	107%
Scanhealth	$114	107%
Kindred	$117	110%
Kelseycare	$144	135%
Community Health Choice	$160	150%
Superior Health Plan	$160	150%
Bright Health	$182	170%
Nx Health	$346	324%
Tchpchip	$457 - $562	428%
Texastruechoice	$719	673%
Coventry	$850	796%
First Health	$850	796%
Healthsmart	$915	857%
Interlink	$915	857%
Multiplan	$980	918%
USA Health Network	$1,111	1040%
Mhealth Network	$1,307	1224%

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 $457.
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 St Luke's Sugar Land 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.