CT scan, pelvis
Facility: Graham County Hospital
Billing Code: 72192 (CPT)
- CPT Billing Code: 72192
- Insurance Median: $484
- Cash Discount Price: $625
- vs. Medicare Baseline: 4.53x 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 453% of the Medicare baseline (a markup of 353%). 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 | $145 - $594 | 136% |
| Medicaid / KanCare | $145 | 136% |
| Blue Cross Blue Shield | $453 | 424% |
| Medicare (plans) | $469 | 439% |
| Celtic Commercial-All Other Plans | $516 | 483% |
| Wppa (Providers Care)-All Plans | $594 | 556% |
Consumer Guidance & Cost Commentary
For a CT scan of the pelvis at Graham County Hospital in Hill City, Kansas, the cash price is $625.00, which matches the facility's median negotiated rate. While the hospital is a Critical Access Hospital owned by the local government, the cash price is significantly higher than the Medicare benchmark of $106.81, reflecting a markup common in commercial billing. It is important to note that while commercial negotiated rates often average 200% to 300% of Medicare, the specific rate for this service is $516.00 when paid through insurance, which is lower than the cash price. This demonstrates that for patients with high-deductible plans, paying cash upfront might not be the most cost-effective option if the insurance negotiated rate is lower than the cash price, though patients should always verify their specific plan's deductible status before proceeding.
Patients should be aware that the facility offers a prompt-pay discount for those who settle their bill in full, which can reduce the final amount owed by bypassing administrative costs associated with insurance claims. Since the facility is in-network for UnitedHealthcare, Medicaid/KanCare, and several other payers, balance billing is generally not an issue for covered services under the No Surprises Act. However, to ensure you receive the best possible rate, you should request a self-pay or prompt-pay classification before check-in and ask for a formal itemized billing audit if you receive a summary bill, as over 80% of hospital bills contain errors that can be corrected. Always confirm the exact allowed amount with the hospital prior to scheduling to avoid unexpected costs.