CMS Price Transparency Data

X-ray, pelvis

Facility: Jacksonville Memorial Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $405
Cash Discount Price: $737
vs. Medicare Baseline: 3.79x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Jacksonville Memorial Hospital is $405. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $737. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.79x the Medicare baseline. Located in 1600 W Walnut St, Jacksonville, IL.

Cash / Self-Pay

$737

Average discount available for prompt cash payment at this facility.

Insurance Median

$405

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: $737 (690%)

Insurance Median: $405 (379%)

Cash: $737 (690% of Medicare)

Ins. Median: $405 (379% 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 379% of the Medicare baseline (a markup of 279%). 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
Blue Cross Blue Shield	$25 - $737	23%
Coventry	$26 - $116	24%
Health Alliance	$26 - $501	24%
Humana	$26 - $629	24%
Medicare (plans)	$26 - $116	24%
Tricare	$26 - $134	24%
UnitedHealthcare	$27 - $531	25%
Corvel/Corcare	$97 - $173	91%
Illinois Workers Compensation	$104 - $194	97%
Medicaid / KanCare	$110	103%
Molina Healthcare	$110	103%
Commercial Workers Compensation	$184	172%
Health Alliance Mh Employee Plan	$339	317%
Current Health Network	$405 - $553	379%
6 Degrees Health	$442	414%
Hope Trust	$442	414%
Hst	$442	414%
Cigna	$511	478%
Aetna	$515 - $590	482%
Healthlink	$626	586%
Phcs/Multiplan	$663	621%
Hfn	$700	655%
Liability	$737	690%

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 $737.
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 Jacksonville Memorial 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.