CT scan, pelvis
Facility: Ellsworth County Medical Center
Billing Code: 72192 (CPT)
- CPT Billing Code: 72192
- Insurance Median: $797
- Cash Discount Price: $885
- vs. Medicare Baseline: 7.46x 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 746% of the Medicare baseline (a markup of 646%). 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 |
|---|---|---|
| Va Ccn-All Plans | $416 | 389% |
| Triwest -All Plans | $416 | 389% |
| Humana | $416 - $841 | 389% |
| Healthy Blue Mcr Adv | $416 | 389% |
| Blue Cross Blue Shield | $430 - $453 | 403% |
| UnitedHealthcare | $575 - $885 | 538% |
| Aetna | $796 | 745% |
| First Health - All Plans | $796 | 745% |
| Cigna | $841 | 787% |
| Healthy Blue Mcaid- All Other Plans | $885 | 829% |
| Coventry Mcaid-All Plans | $885 | 829% |
| Medicaid / KanCare | $885 | 829% |
| Providers Care-Wppa-All Plans | $1,328 | 1243% |
Consumer Guidance & Cost Commentary
For the CT scan of the pelvis at Ellsworth County Medical Center in Ellsworth, Kansas, the facility's cash price is $885.00, which matches the highest negotiated rate paid by UnitedHealthcare and Cigna. This cash rate is significantly higher than the state average for this procedure, indicating that commercial insurance contracts in this region often result in higher out-of-pocket costs for patients compared to paying directly. While the facility offers a cash price of $885.00, patients with high-deductible plans should verify if their specific insurance negotiated rate exceeds this amount, as paying cash upfront could potentially save money. Additionally, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can lower the final cost by 20% to 50%.
The median amount paid by insurance payers for this service is $686.00, which is lower than the cash price but still represents a substantial portion of the gross charge of $885.00. When compared to the Medicare benchmark of $106.81, the facility's rates reflect a significant markup typical of commercial billing structures. If a patient receives care from an out-of-network provider or encounters unexpected ancillary services, they may face balance billing for the difference between the provider's full charge and the insurance allowed amount. To avoid surprise costs, patients should request a full itemized bill before paying and dispute any errors in writing, as over 80% of hospital bills contain mistakes that can be corrected through a formal audit.