CMS Price Transparency Data

X-ray, pelvis

Facility: St Anthony Community Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $145
Cash Discount Price: $2,089
vs. Medicare Baseline: 1.36x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at St Anthony Community Hospital is $145. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,089. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.36x the Medicare baseline. Located in 15 Maple Avenue -19, Warwick, NY.

Cash / Self-Pay

$2,089

Average discount available for prompt cash payment at this facility.

Insurance Median

$145

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: $2,089 (1956%)

Insurance Median: $145 (136%)

Cash: $2,089 (1956% of Medicare)

Ins. Median: $145 (136% 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
Emblem	$47 - $89	44%
Emblem Select Care (Exchange)	$57	53%
Aetna	$60 - $67	56%
Emblem Ghi/Hip PPO	$67	63%
Cigna	$77 - $1,462	72%
Mvp Exchange	$83	78%
Blue Cross Blue Shield	$125 - $772	117%
Medicare (plans)	$130 - $139	122%
Hamaspik (McR)	$130	122%
Mvp Gold (McR)	$130	122%
Tricare	$130	122%
Affinity By Molina McR	$136	127%
Self-Pay	$138	129%
Mvp Hmo/Ppo	$161	151%
Geisinger Health Commercial/Exchange	$429	402%
Self-Pay - Cc 30%	$627	587%
Cdphp	$1,044	977%
Self-Pay - Cc 50%	$1,044	977%
Oxford Commercial	$1,244	1165%
Oxford Exchange	$1,351	1265%
UnitedHealthcare	$1,351 - $1,589	1265%
PHCS	$1,567	1467%
Multiplan	$1,567	1467%
Emblem Ghi/Hip Hmo/Epo/Pos	$1,671	1564%
First Health	$1,776	1663%
Magnacare Preferred	$1,880	1760%
Mvp	$18,190 - $21,438	17030%

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 $2,089.
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 St Anthony Community 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.