CMS Price Transparency Data

X-ray, pelvis

Facility: Medical City Lewisville

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $147
Cash Discount Price: $1,213
vs. Medicare Baseline: 1.38x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Medical City Lewisville is $147. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,213. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.38x the Medicare baseline. Located in 500 West Main Street, Lewisville, TX.

Cash / Self-Pay

$1,213

Average discount available for prompt cash payment at this facility.

Insurance Median

$147

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: $1,213 (1136%)

Insurance Median: $147 (138%)

Cash: $1,213 (1136% of Medicare)

Ins. Median: $147 (138% 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%
Texas Health Network	$28	26%
United	$28 - $245	26%
Cigna	$29 - $170	27%
Aetna	$30 - $882	28%
Molina	$31	29%
Humana	$35 - $92	33%
Superior Health Plan	$85	80%
Blue Cross Blue Shield	$147 - $538	138%
Unicare	$291 - $1,213	272%
Healthcare Highways	$297 - $410	278%
Evry Health	$313	293%
Curative Administrators	$485	454%
City Of Mckinney	$546	511%
Fidelis Securecare	$546	511%
National Choicecare	$606	567%
Pc Texas Partners	$667	624%
Physicians Coop Of Tx	$667	624%
Rockport Health Group	$667	624%
Averde Health, Inc	$703	658%
Usc Health Services	$728	682%
Coastal Comp Health Networks	$849	795%
Jostens	$849	795%
Mega Life	$849	795%
Multiplan Phcs	$849	795%
Healthsmart Preferred Care	$910	852%
Lewisville Isd/Dls Consulting	$910	852%
Usa Managed Care	$970	908%
Galaxy Health Network	$1,031	965%
Independent Medical Systems	$1,213	1136%
National Healthcare Solutions	$1,213	1136%

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 $1,213.
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 Lewisville 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.