CMS Price Transparency Data

X-ray, pelvis

Facility: Thomas Jefferson University Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $97
Cash Discount Price: $124
vs. Medicare Baseline: 0.91x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Thomas Jefferson University Hospital is $97. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $124. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.91x the Medicare baseline. Located in 111 South 11Th Street, Philadelphia, PA.

Cash / Self-Pay

$124

Average discount available for prompt cash payment at this facility.

Insurance Median

$97

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: $124 (116%)

Insurance Median: $97 (91%)

Cash: $124 (116% of Medicare)

Ins. Median: $97 (91% 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
Pa Health_Wellness Chc	$13 - $23	12%
Medicaid / KanCare	$14 - $25	13%
Aetna	$19 - $127	18%
Keystone First	$28 - $49	26%
Cigna	$50 - $101	47%
Ibc	$55 - $87	51%
Upmc Commercial	$59	55%
Jefferson Health Plan Aca Qhp Exchange	$92	86%
Blue Cross Blue Shield	$93	87%
Innovage	$97	91%
Inspira Life	$97	91%
Keystone First Vip Choice	$97 - $99	91%
Medicare (plans)	$97 - $111	91%
Point Of Comfort Refugee Resettlement	$97	91%
St Agnes	$97	91%
Tricare	$97	91%
UnitedHealthcare	$97 - $381	91%
Humana	$99	93%
Devoted Health Participation	$102	95%
Provider Partners Health Plan	$103	96%
Allwell Pa Health_Wellness Ma	$106	99%
Perennial	$112	105%
Highmark Wholecare Gateway	$113	106%
Ibc Employee Benefit	$121	113%
Ibc Main Line Health	$121	113%
Ambetter / Centene	$140	131%
Naphcare	$155 - $184	145%
Geisinger Health Plan	$394	369%

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 $124.
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 Thomas Jefferson University 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.