CMS Price Transparency Data

CT scan, pelvis

Facility: Johnson Memorial Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72192
  • Insurance Median: $432
  • Cash Discount Price: $674
  • vs. Medicare Baseline: 4.04x Medicare
The contracted insurance negotiated median rate for a CT scan, pelvis at Johnson Memorial Hospital is $432. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $674. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.04x the Medicare baseline. Located in 201 Chestnut Hill Road, Stafford Springs, CT.
Cash / Self-Pay
$674

Average discount available for prompt cash payment at this facility.

Insurance Median
$432

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: $674 (631%)
Insurance Median: $432 (404%)
Cash: $674 (631% of Medicare)
Ins. Median: $432 (404% 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 404% of the Medicare baseline (a markup of 304%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Connecticut Dept Of Correction $116 109%
Aetna $123 - $279 115%
Blue Cross Blue Shield $123 - $432 115%
Medicare (plans) $123 - $129 115%
UnitedHealthcare $123 - $1,225 115%
Cca Senior Care Options $125 117%
Cigna $127 - $956 119%
Fallon Health $163 153%
Geha $179 168%
Harvard Pilgrim Healthcare $179 168%
Claimdoc $263 246%
Diversified Administrators $263 246%
Innovative Health Plan Ii $263 246%
1199 National Benefit Fund $279 261%
Allied Benefit Systems $279 261%
Gravie Admin Services $279 261%
Hap $279 261%
Luminare Health $279 261%
Meritain $279 261%
Nippon Life Ins $279 261%
Webtpa $279 261%
Centivo $292 273%
Allegiance $391 366%
Health Partners $391 366%
Magnacare $391 366%
Bcn Domestic $432 404%
Blue Benefit Administrators Of Massachusetts $432 404%
Blue Care Network $432 404%
Blue Distinction Transplant $432 404%
Blue Shield - Ca $432 404%
Blue Shield - Id (Regence) $432 404%
Blue Shield - Ny Highmark Northeastern $432 404%
Blue Shield - Ny Highmark Western $432 404%
Blue Shield - Pa (Highmark) $432 404%
Blue Shield - Wa (Regence) $432 404%
Health Choices $432 404%
Kaiser Domestic $432 404%
Pre-Employment $432 404%
Unicare $432 404%
Wc Domestic $432 404%
Wellpoint $432 404%
Connecticare $537 - $671 503%
Health New England $796 745%
Prime Health Services $980 918%
Allied National Global Care $1,017 952%
Asrm - Reliance Standard Life Insurance $1,017 952%
Christian Care Ministry $1,017 952%
Dean Health $1,017 952%
Family Life Insurance Company $1,017 952%
Ghc Scw $1,017 952%
International Benefit Administrators $1,017 952%
Lifetime Benefit Solutions $1,017 952%
Manhattan Life $1,017 952%
Medi Share $1,017 952%
Multiplan $1,017 952%
Mvp $1,017 952%
Pai $1,017 952%
Pan-American Life $1,017 952%
Paramount Hmo $1,017 952%
Phcs $1,017 952%
Trinity Health Share $1,017 952%
Health Smart $1,041 975%
United Behavioral Health Eap $1,225 1147%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 201 Chestnut Hill Road, Stafford Springs, CT 06076
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals