CMS Price Transparency Data

X-ray, pelvis

Facility: Fhn Memorial Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $112
Cash Discount Price: $123
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Fhn Memorial Hospital is $112. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $123. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.05x the Medicare baseline. Located in 1045 West Stephenson Street, Freeport, IL.

Cash / Self-Pay

$123

Average discount available for prompt cash payment at this facility.

Insurance Median

$112

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: $123 (115%)

Insurance Median: $112 (105%)

Cash: $123 (115% of Medicare)

Ins. Median: $112 (105% 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
Aetna	$8 - $259	7%
Health Alliance Mcr Adv	$8 - $112	7%
Humana	$8 - $368	7%
Quartz Mcr Adv	$8 - $112	7%
UnitedHealthcare	$8 - $363	7%
Osf Healthplans - All Plans	$15 - $466	14%
Ecoh Nihp	$17 - $293	16%
Blue Cross Blue Shield	$19 - $314	18%
Ecoh - All Other Plans	$19 - $317	18%
Nihp Employ - All Plans	$19 - $293	18%
The Alliance - All Plans	$23 - $279	22%
Meridian Health Plan - All Plans	$40 - $49	37%
Quartz - All Other Plans	$70 - $303	66%
Northern Il Hp - All Plans	$80 - $321	75%
Hfn - All Plans	$99 - $382	93%
Galaxy - All Plans	$105 - $419	98%
Health Alliance - All Other Plans	$105 - $419	98%
Interplan Health - All Plans	$105 - $419	98%
Midland Choice - All Plans	$105 - $442	98%
Multiplan Phcs - All Plans	$105 - $396	98%
Preferred Plan Ppo - All Plans	$105 - $419	98%
Wps - All Plans	$105 - $407	98%
Trustmark - All Plans	$107 - $428	100%
First Health - All Plans	$108 - $327	101%
First Choice Il - All Plans	$131 - $396	123%

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 $123.
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 Fhn 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.