CT scan, pelvis
Facility: Nemaha Valley Community Hospital
Billing Code: 72192 (CPT)
- CPT Billing Code: 72192
- Insurance Median: $869
- Cash Discount Price: $1,558
- vs. Medicare Baseline: 8.14x 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 814% of the Medicare baseline (a markup of 714%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $480 | 449% |
| Va Ccn - All Plans | $762 | 713% |
| Humana | $762 | 713% |
| Aetna | $769 - $1,471 | 720% |
| Celtic Comm Exch - All Plans | $838 | 785% |
| Partners Direct Health - All Plans | $900 | 843% |
| Multiplan - All Plans | $1,558 | 1459% |
| Midlands Choice - All Plans | $1,644 | 1539% |
| Health Partners - All Plans | $1,644 | 1539% |
Consumer Guidance & Cost Commentary
For the CPT code 72192 (CT scan, pelvis) at Nemaha Valley Community Hospital in Seneca, KS, the cash price is $1,558.00, which is significantly higher than the state average of $900.00. While commercial insurance plans like Blue Cross Blue Shield and Va Ccn - All Plans have negotiated rates of $480.00 and $762.00 respectively, other payers such as Multiplan and Midlands Choice have negotiated rates of $1,558.00 and $1,644.00. This variation highlights that in-network status does not guarantee the lowest price, as some commercial contracts exceed the cash-pay amount. Patients with high-deductible plans may find it financially advantageous to pay the cash price directly, as it is lower than the negotiated rates for several major insurers.
To ensure you receive the most accurate billing, it is crucial to request an itemized bill before finalizing payment, as summary bills often obscure individual charges and potential errors. If you receive a balance bill for the difference between the provider's full charge and your insurance allowed amount, you may be protected under the No Surprises Act, which bans such billing for emergency care and non-emergency services at in-network facilities. Additionally, you should verify if the facility offers a prompt-pay discount, which could further reduce your out-of-pocket cost if you settle the bill upfront. Always confirm your deductible status and request a self-pay classification prior to scheduling to avoid unexpected administrative fees or automatic claim submissions that void cash discounts.