CMS Price Transparency Data

CT scan, pelvis

Facility: Adventist Health St Helena

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $3,099
Cash Discount Price: $843
vs. Medicare Baseline: 29.01x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Adventist Health St Helena is $3,099. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $843. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 29.01x the Medicare baseline. Located in 10 Woodland Road, Saint Helena, CA.

Cash / Self-Pay

$843

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,099

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: $843 (789%)

Insurance Median: $3,099 (2901%)

Cash: $843 (789% of Medicare)

Ins. Median: $3,099 (2901% 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 2901% of the Medicare baseline (a markup of 2801%). 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
Cigna	$28 - $7,191	26%
Blue Shield Bh Mcr Adv	$55 - $139	51%
Blue Shield Mcr Adv	$55 - $139	51%
Kaiser Mcr Adv	$55 - $139	51%
Tricare	$55 - $139	51%
Ah Employee Health Plan - All Plans	$60 - $250	56%
Interplan-All Plans	$66 - $5,450	62%
Kaiser-All Other Plans	$66 - $7,371	62%
Western Growers-All Plans	$81 - $4,764	76%
Phcs-All Plans	$92 - $4,944	86%
Blue Shield Epn-All Other Plans	$100 - $4,234	94%
Blue Shield Non-Epn	$106 - $4,171	99%
Medi-Cal	$128	120%
UnitedHealthcare	$139 - $5,730	130%
Va Mcr - All Other Plans	$139	130%
Health Management Network-All Plans	$143 - $7,641	134%
Three Rivers-All Plans	$151 - $8,090	141%
Va Medi-Cal	$205	192%
Aetna	$298 - $1,243	279%
Blue Cross Blue Shield	$904 - $1,205	846%
Healthnet-All Plans	$1,060	992%
Blue Shield Behav Hlth	$2,167 - $4,045	2029%
Choicecare-All Plans	$3,371 - $6,292	3156%
Beech Street-All Plans	$3,612 - $6,742	3382%
Galaxy Network-All Plans	$4,334 - $8,090	4058%

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 $843.
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 Adventist Health St Helena 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.