CT scan, pelvis
Facility: Sheridan County Hospital
Billing Code: 72192 (CPT)
- CPT Billing Code: 72192
- Insurance Median: $662
- Cash Discount Price: $914
- vs. Medicare Baseline: 6.20x 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 620% of the Medicare baseline (a markup of 520%). 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 |
|---|---|---|
| Celtic Insurance | $553 | 518% |
| Blue Cross Blue Shield | $662 | 620% |
| UnitedHealthcare | $868 | 813% |
Consumer Guidance & Cost Commentary
For this CT scan of the pelvis at Sheridan County Hospital in Hoxie, KS, the cash price is $914.00, which matches the facility's median paid amount. While the hospital is a Critical Access Hospital owned by the local government, the negotiated rates vary significantly by insurer: Celtic Insurance and Blue Cross Blue Shield have a fixed rate of $662.00, whereas UnitedHealthcare's rate is $868.00. These negotiated amounts are notably lower than the facility's gross charge of $914.00, but they remain higher than the cash price. For patients with high-deductible plans who have not yet met their out-of-pocket maximum, paying the cash price of $914.00 directly may result in lower total costs compared to having insurance process a claim that exceeds the cash rate, provided the patient can afford the upfront payment.
It is important to note that commercial insurance rates often include administrative overhead and do not reflect the true cost of care, which is better represented by the Medicare benchmark of $106.81. In this case, the cash price is approximately 8.5 times the Medicare rate, illustrating how commercial pricing structures can differ vastly from federal benchmarks. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, it does not automatically guarantee the lowest possible price. To minimize costs, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as paying in full upfront can sometimes bypass standard insurance billing cycles and reduce the final amount owed.