CMS Price Transparency Data

X-ray, pelvis

Facility: Johnson Memorial Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72170
  • Insurance Median: $125
  • Cash Discount Price: $173
  • vs. Medicare Baseline: 1.17x Medicare
The contracted insurance negotiated median rate for a X-ray, pelvis at Johnson Memorial Hospital is $125. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $173. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.17x the Medicare baseline. Located in 201 Chestnut Hill Road, Stafford Springs, CT.
Cash / Self-Pay
$173

Average discount available for prompt cash payment at this facility.

Insurance Median
$125

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: $173 (162%)
Insurance Median: $125 (117%)
Cash: $173 (162% of Medicare)
Ins. Median: $125 (117% 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.

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
Aetna $53 - $123 50%
1199 National Benefit Fund $67 63%
Allied Benefit Systems $67 63%
Gravie Admin Services $67 63%
Hap $67 63%
Luminare Health $67 63%
Meritain $67 63%
Nippon Life Ins $67 63%
Webtpa $67 63%
Blue Cross Blue Shield $72 - $123 67%
Bcn Domestic $93 87%
Blue Benefit Administrators Of Massachusetts $93 87%
Blue Care Network $93 87%
Blue Distinction Transplant $93 87%
Blue Shield - Ca $93 87%
Blue Shield - Id (Regence) $93 87%
Blue Shield - Ny Highmark Northeastern $93 87%
Blue Shield - Ny Highmark Western $93 87%
Blue Shield - Pa (Highmark) $93 87%
Blue Shield - Wa (Regence) $93 87%
Health Choices $93 87%
Kaiser Domestic $93 87%
Pre-Employment $93 87%
Unicare $93 87%
Wc Domestic $93 87%
Wellpoint $93 87%
Connecticut Dept Of Correction $116 109%
Medicare (plans) $123 - $129 115%
UnitedHealthcare $123 - $314 115%
Cca Senior Care Options $125 117%
Cigna $127 - $245 119%
Connecticare $136 - $169 127%
Fallon Health $163 153%
Geha $179 168%
Harvard Pilgrim Healthcare $179 168%
Allegiance $200 187%
Health Partners $200 187%
Magnacare $200 187%
Health New England $204 191%
Prime Health Services $251 235%
Allied National Global Care $261 244%
Asrm - Reliance Standard Life Insurance $261 244%
Christian Care Ministry $261 244%
Dean Health $261 244%
Family Life Insurance Company $261 244%
Ghc Scw $261 244%
International Benefit Administrators $261 244%
Lifetime Benefit Solutions $261 244%
Manhattan Life $261 244%
Medi Share $261 244%
Multiplan $261 244%
Mvp $261 244%
Pai $261 244%
Pan-American Life $261 244%
Paramount Hmo $261 244%
Phcs $261 244%
Trinity Health Share $261 244%
Claimdoc $263 246%
Diversified Administrators $263 246%
Innovative Health Plan Ii $263 246%
Health Smart $267 250%
Centivo $292 273%
United Behavioral Health Eap $314 294%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 201 Chestnut Hill Road, Stafford Springs, CT 06076
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals