CT scan, pelvis
Facility: Nmc Health
Billing Code: 72192 (CPT)
- CPT Billing Code: 72192
- Insurance Median: $840
- Cash Discount Price: $980
- vs. Medicare Baseline: 7.86x 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 786% of the Medicare baseline (a markup of 686%). 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 |
|---|---|---|
| Bluestem Pace | $101 | 95% |
| Medicaid / KanCare | $162 | 152% |
| Leading Age | $162 | 152% |
| Aetna | $387 - $1,154 | 362% |
| Blue Cross Blue Shield | $480 | 449% |
| Wppa | $770 | 721% |
| Occunet | $840 | 786% |
| Medincrease Health Plan | $910 | 852% |
| Samaritan Ministries International | $910 | 852% |
| Prime Health Services | $1,050 | 983% |
| UnitedHealthcare | $1,260 | 1180% |
| Cigna | $1,330 | 1245% |
Consumer Guidance & Cost Commentary
For a CT scan of the pelvis at Nmc Health in Newton, Kansas, the facility's cash price of $980 is significantly lower than the state average, which sits at $1,400. While many commercial payers negotiate rates ranging from $101 to $1,330, the cash rate remains the most affordable option for patients without insurance. It is important to note that for individuals with high-deductible plans, paying the cash price upfront can sometimes be cheaper than the insurance negotiated rate, which often includes administrative overhead and exceeds the actual cost of care. Patients should verify if their specific plan has a deductible that would otherwise require them to pay the higher negotiated amount before scheduling.
To ensure you are not overcharged, request a full itemized bill that breaks down every CPT code and unit cost, as summary bills often hide errors or unbundled charges. This facility's negotiated rate of $840 is 7.9% higher than the Medicare benchmark of $106.81, which serves as the objective baseline for fair pricing. Additionally, ask about prompt-pay discounts, which can reduce the final balance by 20% to 50% if paid in full within 30 days, bypassing the costly claims processing cycle that inflates insurance rates. Always confirm your deductible status and request a waiver of insurance submission if you choose to pay cash to avoid automatic claims that could void your discount.