CMS Price Transparency Data

X-ray, pelvis

Facility: Stoughton Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $243
Cash Discount Price: $296
vs. Medicare Baseline: 2.28x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Stoughton Hospital is $243. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $296. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.28x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$296

Average discount available for prompt cash payment at this facility.

Insurance Median

$243

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: $296 (277%)

Insurance Median: $243 (228%)

Cash: $296 (277% of Medicare)

Ins. Median: $243 (228% 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 228% of the Medicare baseline (a markup of 128%). 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
Medicaid / KanCare	$67	63%
Tricare	$128	120%
Healthnet Mcr Adv - All Plans	$143	134%
Dean Health Insurance Med Adv	$151	141%
Humana	$151 - $484	141%
Quartz Mcr Adv	$151	141%
Security Health/First Health - All Plans	$151	141%
Aetna	$161 - $457	151%
Quartz Health Solutions - All Other Lans	$219	205%
UnitedHealthcare	$237 - $430	222%
Dean Health Insurance Comm - All Other Plans	$243	228%
Dean Health Insurance Epo	$243	228%
Geha - All Plans	$404	378%
Cigna	$430	403%
Wisconsin Ppo Ppa Direct - All Plans	$430	403%
Blue Cross Blue Shield	$468	438%
Wps - All Plans	$484	453%
Alliance - All Plans	$2,152	2015%

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 $296.
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 Stoughton 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.