CMS Price Transparency Data

X-ray, pelvis

Facility: Texas Scottish Rite Hospital for Children

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $30
Cash Discount Price: $205
vs. Medicare Baseline: 0.28x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Texas Scottish Rite Hospital for Children is $30. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $205. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.28x the Medicare baseline. Located in 2222 Welborn Street, Dallas, TX.

Cash / Self-Pay

$205

Average discount available for prompt cash payment at this facility.

Insurance Median

$30

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: $205 (192%)

Insurance Median: $30 (28%)

Cash: $205 (192% of Medicare)

Ins. Median: $30 (28% 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	$6 - $172	6%
Tricare	$9 - $33	8%
Blue Cross Blue Shield	$10 - $446	9%
Cigna	$15 - $285	14%
Firstcare Health Comm - All Other Plans	$20 - $266	19%
Healthscope - All Plans	$22 - $285	21%
Scott & White Comm- All Other Plans	$22 - $285	21%
UnitedHealthcare	$22 - $247	21%
Children Med Center Health Plan - All Plans	$29 - $167	27%
Community First Health Plan-All Plans	$29 - $167	27%
Cook Childrens Hp-All Plans	$29 - $167	27%
Driscoll Childrens-All Plans	$29 - $167	27%
Medicaid / KanCare	$29 - $167	27%
Molina Commercial - All Other Plans	$29 - $167	27%
Soonercare-All Plans	$29 - $167	27%
Firstcare Health Mcaid	$30 - $176	28%
Tx Childrens Hlth Mcaid-All Plans	$30 - $176	28%

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 $205.
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 Texas Scottish Rite Hospital for Children 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.