CMS Price Transparency Data

X-ray, pelvis

Facility: Fairfield Medical Center

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $284
Cash Discount Price: $184
vs. Medicare Baseline: 2.66x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Fairfield Medical Center is $284. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $184. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.66x the Medicare baseline. Located in 401 North Ewing Street, Lancaster, OH.

Cash / Self-Pay

$184

Average discount available for prompt cash payment at this facility.

Insurance Median

$284

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: $184 (172%)

Insurance Median: $284 (266%)

Cash: $184 (172% of Medicare)

Ins. Median: $284 (266% 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 266% of the Medicare baseline (a markup of 166%). 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
Caresource	$53 - $7,914	50%
Medicaid / KanCare	$53	50%
Molina	$53 - $10,045	50%
UnitedHealthcare	$53 - $6,088	50%
Blue Cross Blue Shield	$54 - $26,250	51%
Amerihealth Caritas Ohio	$55	51%
Buckeye Community Health	$55 - $9,436	51%
Humana	$55 - $5,966	51%
Aetna	$99 - $5,966	93%
Medical Mutual	$99 - $33,500	93%
Medicare (plans)	$99 - $5,966	93%
Medigold	$101 - $6,088	95%
The Health Plan	$101 - $6,086	95%
Va Ccn	$101 - $6,088	95%
Valor Health Plan	$101 - $6,086	95%
Oscar	$131 - $6,173	123%
Bwc	$140 - $8,456	131%
Allied Benefit Systems	$284	266%
Meritain Health	$284	266%
Quality Care Partners/Ohio Ppo Connect	$294	275%
The Ohio State Health Plan	$315	295%
Cigna	$337	316%
Ohio Healthy	$384	360%
Multiplan	$389	364%
Miscellaneous Plans	$409	383%

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 $184.
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 Fairfield Medical Center 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.