CMS Price Transparency Data

CT scan, pelvis

Facility: Medical City Lewisville

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $141
Cash Discount Price: $3,656
vs. Medicare Baseline: 1.32x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Medical City Lewisville is $141. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,656. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.32x the Medicare baseline. Located in 500 West Main Street, Lewisville, TX.

Cash / Self-Pay

$3,656

Average discount available for prompt cash payment at this facility.

Insurance Median

$141

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: $3,656 (3423%)

Insurance Median: $141 (132%)

Cash: $3,656 (3423% of Medicare)

Ins. Median: $141 (132% 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
Texas Health Network	$103	96%
Amerigroup	$105	98%
Cook Childrens Health Plan	$105	98%
Parkland Community Health Plan	$105	98%
United	$105 - $1,454	98%
Cigna	$110 - $1,023	103%
Aetna	$113 - $5,312	106%
Molina	$115 - $117	108%
Humana	$131 - $367	123%
Blue Cross Blue Shield	$141 - $3,244	132%
Imaging Providers Of Texas	$350	328%
Superior Health Plan	$512	479%
Unicare	$1,754 - $7,307	1642%
Healthcare Highways	$2,470	2313%
City Of Mckinney	$3,288	3078%
Fidelis Securecare	$3,288	3078%
National Choicecare	$3,654	3421%
Pc Texas Partners	$4,019	3763%
Physicians Coop Of Tx	$4,019	3763%
Rockport Health Group	$4,019	3763%
Averde Health, Inc	$4,238	3968%
Usc Health Services	$4,384	4104%
Coastal Comp Health Networks	$5,115	4789%
Jostens	$5,115	4789%
Mega Life	$5,115	4789%
Healthsmart Preferred Care	$5,480	5131%
Lewisville Isd/Dls Consulting	$5,480	5131%
Usa Managed Care	$5,846	5473%
Galaxy Health Network	$6,211	5815%
Independent Medical Systems	$7,307	6841%
National Healthcare Solutions	$7,307	6841%

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 $3,656.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72192.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Medical City Lewisville is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72192.
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.