CT scan, pelvis
Facility: Hiawatha Community Hospital
Billing Code: 72192 (CPT)
- CPT Billing Code: 72192
- Insurance Median: $901
- Cash Discount Price: $1,156
- vs. Medicare Baseline: 8.44x 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 844% of the Medicare baseline (a markup of 744%). 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 | $428 - $993 | 401% |
| Aetna | $428 - $934 | 401% |
| Humana | $432 | 404% |
| Blue Cross Blue Shield | $456 - $480 | 427% |
| Ambetter / Centene | $513 | 480% |
| Centrus Health Direct - All Plans | $867 | 812% |
| Oscar - All Plans | $867 | 812% |
| Preferred Hlth - All Plans | $1,040 | 974% |
| Cigna | $1,098 | 1028% |
| Wppa Providrs Care - All Plans | $1,098 | 1028% |
| Midlands Choice - All Plans | $1,121 | 1050% |
| Multiplan - All Plans | $1,121 | 1050% |
| Healthy Blue Mcaid - All Plans | $1,156 | 1082% |
Consumer Guidance & Cost Commentary
For the CT scan of the pelvis at Hiawatha Community Hospital in Hiawatha, KS, the cash price is $1,156.00, which matches the facility's negotiated median paid amount of $867.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the cash rate is notably higher than the state average for this procedure. Patients with high-deductible plans may find paying cash directly more cost-effective than using insurance, as the negotiated rate of $867.00 exceeds the cash price of $1,156.00 in this specific instance, though the data indicates the cash median is the primary benchmark for self-pay. It is important to note that while the facility offers a cash price, patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront payment incentives can significantly reduce the final bill by bypassing administrative claim processing costs.
Insurance coverage varies widely across the 13 payers represented, with negotiated rates ranging from $428 for UnitedHealthcare and Aetna to $1,156 for Healthy Blue Mcaid. The median negotiated rate across all payers is $901.00, which is lower than the cash price but higher than the Medicare benchmark of $106.81. This significant markup highlights the importance of comparing commercial rates against the Medicare benchmark rather than the hospital's gross chargemaster, as the latter can obscure the true cost of care. To ensure you are receiving fair pricing, we recommend requesting an itemized billing audit to review every line item for potential errors, unbundled codes, or