CMS Price Transparency Data

CT scan, pelvis

Facility: Wilcox Memorial Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $277
Cash Discount Price: $665
vs. Medicare Baseline: 2.59x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Wilcox Memorial Hospital is $277. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $665. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.59x the Medicare baseline. Located in 3-3420 Kuhio Highway, Lihue, HI.

Cash / Self-Pay

$665

Average discount available for prompt cash payment at this facility.

Insurance Median

$277

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: $665 (623%)

Insurance Median: $277 (259%)

Cash: $665 (623% of Medicare)

Ins. Median: $277 (259% 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 259% of the Medicare baseline (a markup of 159%). 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
Alohacare	$92 - $319	86%
Ohana	$95 - $443	89%
Mdx	$126 - $886	118%
Hmsa	$135 - $389	126%
Devoted	$141	132%
UnitedHealthcare	$195 - $277	183%
Hwmg/Hmaa	$223 - $866	209%
Uha	$407	381%
Verdegard	$565 - $886	529%
Hcha	$886	830%
Kaiser	$886	830%
Multiplan	$886 - $942	830%
Pac Admin	$997	933%

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 $665.
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 Wilcox Memorial 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.