CMS Price Transparency Data

CT scan, pelvis

Facility: Pinckneyville Community Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $582
Cash Discount Price: $1,562
vs. Medicare Baseline: 5.45x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Pinckneyville Community Hospital is $582. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,562. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.45x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$1,562

Average discount available for prompt cash payment at this facility.

Insurance Median

$582

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: $1,562 (1462%)

Insurance Median: $582 (545%)

Cash: $1,562 (1462% of Medicare)

Ins. Median: $582 (545% 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 545% of the Medicare baseline (a markup of 445%). 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
Aetna	$20 - $2,532	19%
Ambetter / Centene	$20 - $582	19%
Blue Cross Blue Shield	$20 - $2,025	19%
Medicaid / KanCare	$20 - $582	19%
Umwa Mcr Adv - All Plans	$50 - $1,041	47%
UnitedHealthcare	$50 - $2,307	47%
Wellcare Mcr Adv - All Plans	$50 - $1,041	47%
Humana	$52 - $1,041	49%
Cigna	$60 - $2,321	56%
Healthlink Hmo	$192 - $2,208	180%
Healthlink Ppo - All Other Plans	$192 - $2,321	180%
Phcs Savility	$264 - $2,391	247%
Multiplan - All Plans	$279 - $2,532	261%
Phcs - All Other Plans	$279 - $2,307	261%
Healthlink Work Comp	$2,321	2173%

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 $1,562.
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 Pinckneyville Community 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.