CT scan, pelvis
Facility: Susan B Allen Memorial Hospital
Billing Code: 72192 (CPT)
- CPT Billing Code: 72192
- Insurance Median: $635
- Cash Discount Price: $741
- vs. Medicare Baseline: 5.95x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 595% of the Medicare baseline (a markup of 495%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| UnitedHealthcare | $350 | 328% |
| Providrs Care | $919 | 860% |
Consumer Guidance & Cost Commentary
For a CT scan of the pelvis at Susan B Allen Memorial Hospital in El Dorado, KS, the facility's cash price of $741.00 is significantly lower than the state average markup of 5.9 times the Medicare rate of $106.81. While the hospital's negotiated rates for UnitedHealthcare and Providrs Care are set at $350 and $919 respectively, patients with high-deductible plans may find the cash price more advantageous if their insurance negotiated rate exceeds this amount. It is important to note that commercial insurance rates often include administrative overhead and contract dynamics that can inflate the baseline price by 20% to 40% compared to direct cash payments.
To minimize costs, patients should verify the facility's "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can bypass costly claims processing and administrative fees. Although the data does not list a specific negotiated rate for the patient's specific plan, understanding that in-network rates are contractual ceilings helps avoid the pitfall of assuming the lowest possible price. Additionally, since over 80% of hospital bills contain errors, consumers are encouraged to request a full itemized CPT-coded bill rather than accepting a summary invoice, ensuring they can identify any unbundled codes or services not rendered before finalizing payment.