CMS Price Transparency Data

X-ray, pelvis

Facility: Jefferson Healthcare

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $158
Cash Discount Price: $209
vs. Medicare Baseline: 1.48x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Jefferson Healthcare is $158. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $209. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.48x the Medicare baseline. Located in 834 Sheridan Street, Port Townsend, WA.

Cash / Self-Pay

$209

Average discount available for prompt cash payment at this facility.

Insurance Median

$158

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: $209 (196%)

Insurance Median: $158 (148%)

Cash: $209 (196% of Medicare)

Ins. Median: $158 (148% 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
Tricare	$8 - $174	7%
Chpw Mcr Adv	$9 - $187	8%
Aetna	$10 - $446	9%
Medicare (plans)	$10 - $177	9%
Molina Mcr Adv	$10 - $174	9%
Molina Marketplace-All Other Plans	$11 - $217	10%
Chpw Commercial-All Other Plans	$13 - $422	12%
Coord Care Comm/Exchge-All Other Plans	$14 - $446	13%
Chpw Mcaid	$17 - $155	16%
Molina Mcaid	$17 - $158	16%
Amerigroup Mcaid-All Plans	$18 - $163	17%
Regence-All Other Plans	$19 - $372	18%
Premera-All Plans	$22 - $422	21%
Cigna	$23 - $446	22%
Coord Care Mcaid Ip/Op Only	$166	155%
UnitedHealthcare	$278	260%
Coord Care Cascade Ip/Op Only	$446	418%

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 $209.
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 Healthcare 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.