CT scan, pelvis
Facility: Kansas City Orthopaedic Institute
Billing Code: 72192 (CPT)
- CPT Billing Code: 72192
- Insurance Median: $254
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.38x 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 238% of the Medicare baseline (a markup of 138%). 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 | $98 | 92% |
| Aetna | $98 | 92% |
| Cigna | $100 | 94% |
| Blue Cross Blue Shield | $254 | 238% |
Consumer Guidance & Cost Commentary
For the CPT code 72192 (CT scan, pelvis) at Kansas City Orthopaedic Institute in Leawood, KS, the facility's negotiated rate of $254.00 is significantly higher than the state average, which is $106.81. This represents a markup of 2.4 times the Medicare benchmark, a common pattern where commercial contracts exceed the federal cost baseline due to administrative overhead and network tiering. While the facility is in-network for UnitedHealthcare, Aetna, Cigna, and Blue Cross Blue Shield, patients should be aware that cash-pay options are often more economical for those with high-deductible plans, as the cash median is not listed but could theoretically be lower than the insurer's allowed amount. It is crucial to verify "self-pay" or "prompt-pay" discounts directly with the hospital before scheduling, as these upfront incentives can bypass the administrative costs embedded in the negotiated rate.
Patients should also exercise caution regarding balance billing and billing errors, even when using in-network insurance. Although the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, unexpected charges can still arise from ancillary services or coding mistakes. Since over 80% of hospital bills contain errors, consumers should request a full itemized CPT-coded statement rather than accepting a summary bill, which may obscure unbundled charges or services not rendered. If a discrepancy is found, a formal written audit dispute sent to the billing supervisor is the most effective method to resolve the issue, ensuring that the final invoice reflects only the accurate, contracted rate of $254.00 or a valid cash discount.