CMS Price Transparency Data

X-ray, pelvis

Facility: Freestone Medical Center

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $171
Cash Discount Price: $399
vs. Medicare Baseline: 1.60x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Freestone Medical Center is $171. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $399. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.60x the Medicare baseline. Located in 125 Newman St, Fairfield, TX.

Cash / Self-Pay

$399

Average discount available for prompt cash payment at this facility.

Insurance Median

$171

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: $399 (374%)

Insurance Median: $171 (160%)

Cash: $399 (374% of Medicare)

Ins. Median: $171 (160% 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
Aarp	$56	52%
Apwu	$56	52%
Fringe Benefits	$56	52%
Geha	$56	52%
Uhcss	$56	52%
UnitedHealthcare	$56 - $171	52%
Blue Cross Blue Shield	$74 - $513	69%
Gilsbar	$97 - $570	91%
Mcaid	$120 - $135	112%
Misc Mcaid Hmo	$120 - $171	112%
Superior Health Chip	$120 - $135	112%
Tx Childrens Mcaid	$120 - $135	112%
Amerigroup	$157 - $171	147%
Medicaid / KanCare	$159 - $296	149%
Rightcare S&W Mcaid	$159 - $171	149%
Superior Health Mcd	$159 - $296	149%
Cigna	$342	320%
Misc Multiplan	$399	374%
Misc Multiplan Auto	$399	374%
Misc Multiplan Workcomp	$399	374%
Self Pay Gt 083123	$399	374%
Self Pay Lt 090123	$399	374%
Aetna	$456	427%
Aflac	$570	534%
Bankers Life	$570	534%
Fairview Nursing Home	$570	534%
Humana	$570	534%
Icare	$570	534%
Inmate Freestone Co	$570	534%
Misc Hospice	$570	534%
Miscellaneous	$570	534%
Miscellaneous Auto	$570	534%
Mutual Of Omaha	$570	534%
North American Med Empl	$570	534%
Standard Life Insurance	$570	534%
Tml	$570	534%
Zelis Healthcare	$570	534%

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 $399.
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 Freestone 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.