CMS Price Transparency Data

X-ray, pelvis

Facility: Jefferson County Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $265
Cash Discount Price: $143
vs. Medicare Baseline: 2.48x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Jefferson County Hospital is $265. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $143. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.48x the Medicare baseline. Located in Intersection Hyws 81 & 70, Waurika, OK.

Cash / Self-Pay

$143

Average discount available for prompt cash payment at this facility.

Insurance Median

$265

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: $143 (134%)

Insurance Median: $265 (248%)

Cash: $143 (134% of Medicare)

Ins. Median: $265 (248% 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 248% of the Medicare baseline (a markup of 148%). 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	$85	80%
Medica	$171	160%
Healthcare Highways	$180 - $265	169%
Humana	$220	206%
Friday Health Plan	$238	223%
UnitedHealthcare	$277	259%
Oklahoma Health Network (Ohn)	$326	305%
Aetna	$347	325%
Coventry	$347	325%
Cigna	$367	344%
First Health	$367	344%
Osma Health	$367	344%
Preferred Community Choice	$375	351%
Healthsmart	$384	360%

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 $143.
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 Jefferson 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.