CMS Price Transparency Data

X-ray, pelvis

Facility: Lewisgale Medical Center

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $733
Cash Discount Price: $1,047
vs. Medicare Baseline: 6.86x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Lewisgale Medical Center is $733. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,047. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 6.86x the Medicare baseline. Located in 1900 Electric Road, Salem, VA.

Cash / Self-Pay

$1,047

Average discount available for prompt cash payment at this facility.

Insurance Median

$733

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: $1,047 (980%)

Insurance Median: $733 (686%)

Cash: $1,047 (980% of Medicare)

Ins. Median: $733 (686% 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 686% of the Medicare baseline (a markup of 586%). 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
Blue Cross Blue Shield	$38 - $147	36%
Cigna	$182	170%
Lifeworks	$199	186%
Universal Healthcare Group	$230	215%
United	$245 - $471	229%
Virginia Health Network	$366 - $743	343%
Naphcare	$524	491%
Greenvbrier Sporting Club	$628	588%
Graham-White Manufacturing	$733	686%
Richfield Nursing Center	$733	686%
Corvel	$754	706%
Community Care Network	$785	735%
Richfield Retirement Community	$785	735%
Csx Hotels	$838	785%
Occunet Workers Comp	$838	785%
One Health Plan	$838	785%
Patients Choice	$921	862%
4Most	$942	882%
Alleghany Highland Community	$942	882%
American Postal Workers Union	$942	882%
C&O Employees Hospital Assn	$942	882%
Multiplan	$942	882%
Phcs	$942	882%
Star Transportation	$942	882%

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 $1,047.
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 Lewisgale 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.