CMS Price Transparency Data

X-ray, pelvis

Facility: Ascension Ne Wisconsin - St Elizabeth Campus

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $68
Cash Discount Price: $63
vs. Medicare Baseline: 0.64x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Ascension Ne Wisconsin - St Elizabeth Campus is $68. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $63. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.64x the Medicare baseline. Located in 1506 S Oneida St, Appleton, WI.

Cash / Self-Pay

$63

Average discount available for prompt cash payment at this facility.

Insurance Median

$68

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: $63 (59%)

Insurance Median: $68 (64%)

Cash: $63 (59% of Medicare)

Ins. Median: $68 (64% 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
Blue Cross Blue Shield	$9	8%
Cchp	$21 - $69	20%
Centivo Nw1	$21 - $68	20%
Centivo Nw3	$21 - $68	20%
Medicare (plans)	$102	95%
Veterans Administration	$102	95%
Wellcare	$107	100%
Smarthealth	$143	134%
Molina Marketplace	$215	201%

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 $63.
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 Ascension Ne Wisconsin - St Elizabeth Campus 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.