CMS Price Transparency Data

X-ray, pelvis

Facility: Lonesome Pine Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $107
Cash Discount Price: $66
vs. Medicare Baseline: 1.00x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Lonesome Pine Hospital is $107. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $66. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.00x the Medicare baseline. Located in 1990 Holton Avenue East, Big Stone Gap, VA.

Cash / Self-Pay

$66

Average discount available for prompt cash payment at this facility.

Insurance Median

$107

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: $66 (62%)

Insurance Median: $107 (100%)

Cash: $66 (62% of Medicare)

Ins. Median: $107 (100% 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
UnitedHealthcare	$22 - $370	21%
Blue Cross Blue Shield	$29 - $439	27%
Cigna	$37 - $170	35%
Optima Health	$73	68%
Aetna	$74 - $187	69%
Molina Healthcare	$74 - $107	69%
Amerigroup	$102	95%
Humana	$102	95%
Managed Medicaire	$102	95%
Medicare (plans)	$102	95%
Sentara Health	$102 - $111	95%
United Mine Workers Of America	$102	95%
Devoted Health Plan	$107	100%
Mountain Empire Pace	$107	100%
Nhc Advantage	$107	100%
Wellcare	$108	101%
Medcost	$209	196%
Ambetter / Centene	$222	208%
Seven Corners, Inc.	$245	229%
First Health Coventry	$395	370%

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 $66.
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 Lonesome Pine 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.