CMS Price Transparency Data

X-ray, pelvis

Facility: Jeff Davis Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $224
Cash Discount Price: $105
vs. Medicare Baseline: 2.10x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Jeff Davis Hospital is $224. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $105. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.10x the Medicare baseline. Located in 163 South Tallahassee Street, Hazlehurst, GA.

Cash / Self-Pay

$105

Average discount available for prompt cash payment at this facility.

Insurance Median

$224

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: $105 (98%)

Insurance Median: $224 (210%)

Cash: $105 (98% of Medicare)

Ins. Median: $224 (210% 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 210% of the Medicare baseline (a markup of 110%). 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
Pen_Network	$39	37%
Medicaid / KanCare	$58 - $160	54%
Humana	$59 - $254	55%
Peach_State	$59	55%
Wellcare	$59	55%
Medicare (plans)	$93 - $94	87%
Blue Cross Blue Shield	$95 - $224	89%
Care_Improvement_Plus	$95	89%
Coventry_Hmo	$209	196%
Coventry_Pos	$209	196%
Uhc_Hmo	$224	210%
Uhc_Indemnity	$224	210%
Uhc_Ppo	$224	210%
Coventry_Ppo	$230	215%
Beech_Street	$239	224%
Care_Source	$239	224%
Cigna	$239	224%
One_Health_Ppo	$239	224%
Choicecare	$254	238%
Community_Care_Network	$254	238%
Georgia_Hospital_Network	$254	238%
Industry_Buying_Group	$254	238%
Novanet	$254	238%
Principal_Health_Care_Of_Georgia	$254	238%
Three_Rivers_Provider_Network	$254	238%
Usa_Managed_Care	$254	238%
Memorial_Health_Partners	$269	252%
Tricare	$278	260%
Multiplan	$284	266%

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 $105.
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 Jeff Davis 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.