CMS Price Transparency Data

X-ray, pelvis

Facility: Primary Children's Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72170
  • Insurance Median: $146
  • Cash Discount Price: $154
  • vs. Medicare Baseline: 1.37x Medicare
The contracted insurance negotiated median rate for a X-ray, pelvis at Primary Children's Hospital is $146. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $154. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.37x the Medicare baseline. Located in 100 North Mario Capecchi Drive, Salt Lake City, UT.
Cash / Self-Pay
$154

Average discount available for prompt cash payment at this facility.

Insurance Median
$146

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: $154 (144%)
Insurance Median: $146 (137%)
Cash: $154 (144% of Medicare)
Ins. Median: $146 (137% 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.

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
American Health $8 - $117 7%
Health Plan Of Nevada $8 - $52 7%
Healthy U $8 - $61 7%
Molina $8 - $172 7%
Selecthealth $8 - $172 7%
Southwest Behavioral Health $8 - $100 7%
UnitedHealthcare $8 - $172 7%
Donor Connect $74 - $82 69%
Tricare $102 95%
Triwest $102 95%
Aetna $146 - $174 137%
Awh Connected $146 - $174 137%
Byu Athletics $146 - $172 137%
Campbell Scientific $146 - $172 137%
Cigna $146 - $172 137%
Deseret Mutual $146 - $172 137%
Emi $146 - $172 137%
Emi Health $146 - $172 137%
First Choice $146 - $172 137%
First Choice Of The Midwest $146 - $172 137%
Franklin County $146 - $172 137%
Global Excel $146 - $172 137%
Health Utah $146 - $172 137%
Humana $146 - $172 137%
Hygeia Corporation $146 - $172 137%
Ifit $146 - $172 137%
Juniper Systems $146 - $172 137%
Lw Miller $146 - $172 137%
Managed Care Admin $146 - $172 137%
Medcare International $146 - $172 137%
Motivhealth $146 - $172 137%
Pehp $146 - $172 137%
Prodegi Corp Benefit $146 - $172 137%
Tanner Llc $146 - $172 137%
Uofu $146 - $172 137%
Utah Tech $146 - $172 137%
Wise Network $146 - $172 137%
First Health $148 - $174 139%
Blue Cross Blue Shield $150 - $176 140%
Springtide $150 - $176 140%
Utah Behavioral Health Network $166 155%
Altius Mhnet Behavioral Health $181 169%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 100 North Mario Capecchi Drive, Salt Lake City, UT 84113
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Childrens