CMS Price Transparency Data

X-ray, pelvis

Facility: Medical City Fort Worth

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $133
Cash Discount Price: $751
vs. Medicare Baseline: 1.25x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Medical City Fort Worth is $133. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $751. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.25x the Medicare baseline. Located in 900 Eighth Avenue, Fort Worth, TX.

Cash / Self-Pay

$751

Average discount available for prompt cash payment at this facility.

Insurance Median

$133

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: $751 (703%)

Insurance Median: $133 (125%)

Cash: $751 (703% of Medicare)

Ins. Median: $133 (125% 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
Amerigroup	$28	26%
Cook Childrens Health Plan	$28	26%
Parkland Community Health Plan	$28	26%
United	$28 - $245	26%
Cigna	$29 - $398	27%
Healthspring Life	$29	27%
Aetna	$30 - $442	28%
Molina	$31	29%
Humana	$35 - $92	33%
Superior Health Plan	$53	50%
Blue Cross Blue Shield	$133 - $479	125%
Unicare	$165 - $751	154%
Healthcare Highways	$184 - $254	172%
Evry Health	$194	182%
Curative Administrators	$300	281%
City Of Mckinney	$338	316%
Fidelis Securecare	$338	316%
Emerging Therapy Solutions	$375 - $540	351%
National Choicecare	$375	351%
Pc Texas Partners	$413	387%
Physicians Coop Of Tx	$413	387%
Rockport Health Group	$413	387%
Averde Health, Inc	$435	407%
Coastal Comp Health Networks	$525	492%
Mega Life	$525	492%
Multiplan Phcs	$525	492%
Healthsmart Preferred Care	$533	499%
Lewisville Isd/Dls Consulting	$563	527%
Usa Managed Care	$600	562%
Usc Health Services	$600	562%
Galaxy Health Network	$638	597%
UnitedHealthcare	$645	604%
Independent Medical Systems	$751	703%
National Healthcare Solutions	$751	703%

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 $751.
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 Medical City Fort Worth 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.