CMS Price Transparency Data

CT scan, chest (no contrast)

Facility: Daviess Community Hospital

Billing Code: 71250 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 71250
Insurance Median: $122
Cash Discount Price: $592
vs. Medicare Baseline: 1.14x Medicare

The contracted insurance negotiated median rate for a CT scan, chest (no contrast) at Daviess Community Hospital is $122. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $592. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.14x the Medicare baseline. Located in 1314 E Walnut St, Washington, IN.

Cash / Self-Pay

$592

Average discount available for prompt cash payment at this facility.

Insurance Median

$122

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: $592 (554%)

Insurance Median: $122 (114%)

Cash: $592 (554% of Medicare)

Ins. Median: $122 (114% 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.

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	$48 - $1,586	45%
Blue Cross Blue Shield	$48 - $1,303	45%
Encore Ppo-All Plans	$48 - $850	45%
Humana	$48 - $146	45%
UnitedHealthcare	$50 - $1,332	47%
St. Vincent Health - All Plans	$52 - $1,031	49%
Patoka Valley-All Plans	$53 - $793	50%
Mdwise Marketplace-All Plans	$91 - $208	85%
Siho-All Plans	$95 - $1,427	89%
Caresource Mcaid-All Plans	$98 - $106	92%
Hoosier Healthwise Mcaid-All Plans	$98 - $106	92%
Sagamore Valley-All Plans	$102 - $1,538	95%

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 $592.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 71250.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Daviess Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 71250.
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.