CMS Price Transparency Data

CT scan, pelvis

Facility: Rio Grande Regional Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $2,710
Cash Discount Price: $12,997
vs. Medicare Baseline: 25.37x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Rio Grande Regional Hospital is $2,710. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $12,997. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 25.37x the Medicare baseline. Located in 101 E Ridge Rd, McAllen, TX.

Cash / Self-Pay

$12,997

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,710

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: $12,997 (12168%)

Insurance Median: $2,710 (2537%)

Cash: $12,997 (12168% of Medicare)

Ins. Median: $2,710 (2537% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 2537% of the Medicare baseline (a markup of 2437%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$104	97%
Driscoll Children'S Health Plan	$108	101%
United	$109 - $6,179	102%
Aetna	$115 - $2,476	108%
Molina Healthcare	$115	108%
Blue Cross Blue Shield	$419 - $6,179	392%
Humana	$439	411%
Superior Health Plan	$858 - $961	803%
Texas Workforce Commission	$2,943 - $3,296	2755%
Averde Health	$4,047 - $4,531	3789%
Healthsmart Preferred Care	$5,273 - $11,672	4937%
First Health	$7,051 - $7,896	6601%
National Healthcare Solutions	$7,357 - $8,239	6888%
Southwest Medical	$7,357 - $8,239	6888%
Coastal Comp	$7,971 - $8,925	7463%
Ppo Next/ Medical Control	$9,197 - $10,299	8611%
Beech Street	$9,810 - $10,985	9185%
Multiplan	$9,810 - $10,985	9185%
Usa Managed Care	$9,810 - $10,985	9185%

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 $12,997.
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 Rio Grande Regional Hospital 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.