CT scan, pelvis
Facility: Medicine Lodge Memorial Hospital
Billing Code: 72192 (CPT)
- CPT Billing Code: 72192
- Insurance Median: $601
- Cash Discount Price: $633
- vs. Medicare Baseline: 5.63x 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 563% of the Medicare baseline (a markup of 463%). 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 |
|---|---|---|
| Tricare | $507 | 475% |
| Humana | $576 | 539% |
| Aetna | $585 - $633 | 548% |
| Hpk-All Plans | $601 | 563% |
| UnitedHealthcare | $601 | 563% |
| Medicaid / KanCare | $633 | 593% |
Consumer Guidance & Cost Commentary
For a CT scan of the pelvis at Medicine Lodge Memorial Hospital in Medicine Lodge, Kansas, the cash price is $633.00, which matches the facility's gross charge and the median amount paid by Medicaid/KanCare. While the facility is a Critical Access Hospital owned by a Government Hospital District, the data does not provide specific county or state average rates for comparison. It is important to note that for patients with high-deductible plans, paying the cash price of $633.00 upfront can sometimes be more cost-effective than relying on insurance, as commercial negotiated rates for this service range from $507 to $633 depending on the specific payer. Patients should verify their specific plan's deductible status and ask the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can reduce the final bill.
The Medicare benchmark for this procedure is $106.81, which serves as a baseline to evaluate the facility's pricing markup. The median negotiated rate across payers is $601.00, which is slightly lower than the cash price, though some payers like Aetna have a range extending up to the gross charge. Because the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, patients should not fear unexpected bills for this service if the hospital is in-network. However, if a patient receives an itemized bill that appears higher than the negotiated amount, they should request a formal written audit to identify potential errors, such as unbundled codes or services not rendered, rather than accepting a summary bill immediately.