CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Freestone Medical Center

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 74177
  • Insurance Median: $2,057
  • Cash Discount Price: $5,155
  • vs. Medicare Baseline: 5.77x Medicare
The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Freestone Medical Center is $2,057. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,155. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 5.77x the Medicare baseline. Located in 125 Newman St, Fairfield, TX.
Cash / Self-Pay
$5,155

Average discount available for prompt cash payment at this facility.

Insurance Median
$2,057

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$356.43

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $356.43 (100%)
Cash / Self-Pay: $5,155 (1446%)
Insurance Median: $2,057 (577%)
Cash: $5,155 (1446% of Medicare)
Ins. Median: $2,057 (577% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $356.43 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 577% of the Medicare baseline (a markup of 477%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 $164 - $4,787 46%
Gilsbar $339 - $7,364 95%
Mcaid $464 - $1,547 130%
Misc Mcaid Hmo $464 - $2,209 130%
Superior Health Chip $464 - $1,547 130%
Tx Childrens Mcaid $464 - $1,547 130%
UnitedHealthcare $464 - $2,209 130%
Amerigroup $552 - $2,209 155%
Medicaid / KanCare $552 - $3,402 155%
Rightcare S&W Mcaid $552 - $2,209 155%
Superior Health Mcd $552 - $3,402 155%
Aarp $726 204%
Apwu $726 204%
Fringe Benefits $726 204%
Geha $726 204%
Uhcss $726 204%
Aetna $1,302 - $5,892 365%
Cigna $4,419 1240%
Misc Multiplan $5,155 1446%
Misc Multiplan Auto $5,155 1446%
Misc Multiplan Workcomp $5,155 1446%
Self Pay Gt 083123 $5,155 1446%
Self Pay Lt 090123 $5,155 1446%
Aflac $7,364 2066%
Bankers Life $7,364 2066%
Fairview Nursing Home $7,364 2066%
Humana $7,364 2066%
Icare $7,364 2066%
Inmate Freestone Co $7,364 2066%
Misc Hospice $7,364 2066%
Miscellaneous $7,364 2066%
Miscellaneous Auto $7,364 2066%
Mutual Of Omaha $7,364 2066%
North American Med Empl $7,364 2066%
Standard Life Insurance $7,364 2066%
Tml $7,364 2066%
Zelis Healthcare $7,364 2066%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 125 Newman St, Fairfield, TX 75840
  • CMS Rating: No CMS Rating
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Acute Care Hospitals