CMS Price Transparency Data

X-ray, pelvis

Facility: Johnson County Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $195
Cash Discount Price: $249
vs. Medicare Baseline: 1.83x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Johnson County Hospital is $195. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $249. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.83x the Medicare baseline. Located in 202 High St, Tecumseh, NE.

Cash / Self-Pay

$249

Average discount available for prompt cash payment at this facility.

Insurance Median

$195

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: $249 (233%)

Insurance Median: $195 (183%)

Cash: $249 (233% of Medicare)

Ins. Median: $195 (183% 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
Coventry	$114 - $219	107%
Molina Healthcare Of Nebraska	$114 - $219	107%
Va Ccn	$114 - $219	107%
Wellcare	$114 - $219	107%
Midland'S Choice	$136 - $262	127%
Ambetter / Centene	$153 - $294	143%
Blue Cross Blue Shield	$162 - $311	152%
UnitedHealthcare	$165 - $317	154%
Aetna	$170 - $327	159%

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 $249.
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 Johnson County 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.