CMS Price Transparency Data

CT scan, pelvis

Facility: HSHS St Elizabeth's Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $2,608
Cash Discount Price: $2,362
vs. Medicare Baseline: 24.42x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at HSHS St Elizabeth's Hospital is $2,608. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,362. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 24.42x the Medicare baseline. Located in One St Elizabeth Boulevard, O Fallon, IL.

Cash / Self-Pay

$2,362

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,608

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: $2,362 (2211%)

Insurance Median: $2,608 (2442%)

Cash: $2,362 (2211% of Medicare)

Ins. Median: $2,608 (2442% 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 2442% of the Medicare baseline (a markup of 2342%). 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
Molina Healthcare	$97 - $124	91%
Meridian Health Plan	$102	95%
Aetna	$119 - $2,310	111%
Blue Cross Blue Shield	$119 - $3,281	111%
Clear Spring Health Of Illinois	$119	111%
Health Alliance Medical Plans	$119 - $2,789	111%
Health Partners	$119	111%
Humana	$119	111%
Sae Hospice	$119	111%
UnitedHealthcare	$119 - $3,281	111%
Celtic Insurance Company	$237	222%
Naphcare	$257	241%
Hopetrust	$285	267%
Claim Doc	$297	278%
Amish Community	$919	860%
Wellfirst	$2,113	1978%
Cigna	$2,290 - $3,281	2144%
First Health	$2,441	2285%
Healthlink	$2,608 - $3,281	2442%
Caterpillar, Inc.	$2,635	2467%
Consociate Group	$2,887	2703%
Choicecare	$2,953	2765%
Healthcare Finest Network (Hfn)	$2,953	2765%
Multiplan/Phcs	$2,953	2765%
Provider Network Of America	$2,953	2765%
City Of Springfield	$3,281	3072%
Current Health Solutions	$3,281	3072%
Healthscope	$3,281	3072%
Illinois Breast And Cervical Cancer Program	$3,281	3072%
Interplan	$3,281	3072%
Live360	$3,281	3072%
Wexford	$3,281	3072%

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 $2,362.
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 HSHS St Elizabeth's 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.