CMS Price Transparency Data

X-ray, pelvis

Facility: Gundersen Moundview Hospital and Clinics

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72170
  • Insurance Median: $262
  • Cash Discount Price: $185
  • vs. Medicare Baseline: 2.45x Medicare
The contracted insurance negotiated median rate for a X-ray, pelvis at Gundersen Moundview Hospital and Clinics is $262. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $185. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.45x the Medicare baseline. Located in 402 W Lake St, Friendship, WI.
Cash / Self-Pay
$185

Average discount available for prompt cash payment at this facility.

Insurance Median
$262

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: $185 (173%)
Insurance Median: $262 (245%)
Cash: $185 (173% of Medicare)
Ins. Median: $262 (245% 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 245% of the Medicare baseline (a markup of 145%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

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
Amerigroup $24 22%
Blue Cross Blue Shield $166 - $524 155%
Health Partners $166 - $319 155%
Security Health Plan $166 155%
Ucare $166 - $289 155%
Iowa Total Care $172 161%
Managed Health Service $172 161%
Quartz $197 184%
UnitedHealthcare $224 210%
Wps $278 260%
Wps - Arise $278 260%
Alliance $289 - $343 271%
Aspirus Arise Health $300 281%
Humana $307 287%
Multiplan/Healtheos $318 - $347 298%
Coventry Health Care $343 321%
Dean Health Plan $535 501%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 402 W Lake St, Friendship, WI 53934
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals