CMS Price Transparency Data

X-ray, pelvis

Facility: Holy Cross Hospital - Salt Lake

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $261
Cash Discount Price: $221
vs. Medicare Baseline: 2.44x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Holy Cross Hospital - Salt Lake is $261. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $221. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.44x the Medicare baseline. Located in 1050 East South Temple, Salt Lake City, UT.

Cash / Self-Pay

$221

Average discount available for prompt cash payment at this facility.

Insurance Median

$261

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: $221 (207%)

Insurance Median: $261 (244%)

Cash: $221 (207% of Medicare)

Ins. Median: $261 (244% 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 244% of the Medicare baseline (a markup of 144%). 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
Denver Health	$15	14%
Health Choice	$15	14%
Medicaid / KanCare	$15	14%
Rocky Mountain Health Plan	$15	14%
Uuhp	$15 - $113	14%
Humana	$17	16%
Medicare (plans)	$17	16%
Employer Direct Healthcare	$22	21%
Motivhealth	$23	22%
Molina	$41 - $237	38%
UnitedHealthcare	$71	66%
Centura Employee Plan	$91	85%
Blue Cross Blue Shield	$105 - $331	98%
Cigna	$112 - $442	105%
Pehp	$236 - $552	221%
Aetna	$244 - $467	228%
Wise	$287 - $293	269%
Deseret Mutual Benefit Administrators	$339	317%
Select Health	$365	342%
Multiplan	$381 - $502	357%
Emi Health	$552	517%

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 $221.
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 Holy Cross Hospital - Salt Lake 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.