CMS Price Transparency Data

CT scan, pelvis

Facility: St Marys Good Samaritan Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $540
Cash Discount Price: $1,300
vs. Medicare Baseline: 5.06x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at St Marys Good Samaritan Hospital is $540. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,300. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.06x the Medicare baseline. Located in 5401 Lake Oconee Parkway, Greensboro, GA.

Cash / Self-Pay

$1,300

Average discount available for prompt cash payment at this facility.

Insurance Median

$540

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: $1,300 (1217%)

Insurance Median: $540 (506%)

Cash: $1,300 (1217% of Medicare)

Ins. Median: $540 (506% 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 506% of the Medicare baseline (a markup of 406%). 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
Peach State	$257	241%
Wellcare	$257 - $540	241%
Blue Cross Blue Shield	$387 - $1,445	362%
Aetna	$540 - $1,600	506%
Ambetter / Centene	$540	506%
Care Improvement Plus	$540	506%
Caresource	$540	506%
Cigna	$540 - $1,640	506%
Coventry	$540 - $1,500	506%
Eon Health Plan	$540	506%
Humana	$540 - $1,500	506%
Kaiser Permanente	$540	506%
Molina	$540	506%
Pruitthealth Premier	$540	506%
Todays Options Pffs	$540	506%
Todays Options Ppo	$540	506%
UnitedHealthcare	$540 - $2,632	506%
Vaccn United	$540	506%
First Health	$1,500	1404%
Phcs	$1,500	1404%
Meritain	$1,600	1498%
Multiplan	$1,700 - $1,740	1592%
Nova	$1,700 - $1,800	1592%
Three Rivers Provider Network	$1,800	1685%
Amerigroup	$2,000	1872%

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 $1,300.
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 St Marys Good Samaritan 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.