CMS Price Transparency Data

CT scan, pelvis

Facility: Jeff Davis Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72192
  • Insurance Median: $875
  • Cash Discount Price: $408
  • vs. Medicare Baseline: 8.19x Medicare
The contracted insurance negotiated median rate for a CT scan, pelvis at Jeff Davis Hospital is $875. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $408. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 8.19x the Medicare baseline. Located in 163 South Tallahassee Street, Hazlehurst, GA.
Cash / Self-Pay
$408

Average discount available for prompt cash payment at this facility.

Insurance Median
$875

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: $408 (382%)
Insurance Median: $875 (819%)
Cash: $408 (382% of Medicare)
Ins. Median: $875 (819% 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 819% of the Medicare baseline (a markup of 719%). 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
Pen_Network $193 181%
Medicaid / KanCare $227 - $625 213%
Humana $232 - $991 217%
Peach_State $232 217%
Wellcare $232 217%
Medicare (plans) $362 - $365 339%
Blue Cross Blue Shield $369 - $875 345%
Care_Improvement_Plus $369 345%
Coventry_Hmo $816 764%
Coventry_Pos $816 764%
Uhc_Hmo $875 819%
Uhc_Indemnity $875 819%
Uhc_Ppo $875 819%
Coventry_Ppo $898 841%
Beech_Street $933 874%
Care_Source $933 874%
Cigna $933 874%
One_Health_Ppo $933 874%
Choicecare $991 928%
Community_Care_Network $991 928%
Georgia_Hospital_Network $991 928%
Industry_Buying_Group $991 928%
Novanet $991 928%
Principal_Health_Care_Of_Georgia $991 928%
Three_Rivers_Provider_Network $991 928%
Usa_Managed_Care $991 928%
Memorial_Health_Partners $1,050 983%
Tricare $1,085 1016%
Multiplan $1,108 1037%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 163 South Tallahassee Street, Hazlehurst, GA 31539
  • CMS Rating: No CMS Rating
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Critical Access Hospitals