CT scan, pelvis
Facility: Lincoln County Hospital
Billing Code: 72192 (CPT)
- CPT Billing Code: 72192
- Insurance Median: $480
- Cash Discount Price: $1,193
- vs. Medicare Baseline: 4.49x 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 449% of the Medicare baseline (a markup of 349%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $480 | 449% |
Consumer Guidance & Cost Commentary
For this CT scan of the pelvis at Lincoln County Hospital in Lincoln, KS, the facility's negotiated rate with Blue Cross Blue Shield is $480, while the cash-pay median is $1,193. This represents a significant difference, illustrating that paying out-of-pocket can sometimes be more expensive than using insurance if the negotiated rate is lower. However, for patients with high-deductible plans where the insurance allowed amount exceeds the cash price, paying cash upfront may result in lower out-of-pocket costs. It is important to note that the facility is a Critical Access Hospital owned by the local government, and while the data shows a single payer plan, patients should always verify their specific deductible status and ask the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling, as these incentives can reduce the final bill.
The pricing for this service is benchmarked against federal standards, with the Medicare amount set at $106.81. The facility's negotiated rate of $480 is approximately 4.5 times the Medicare rate, which is higher than the typical fair pricing range of 120% to 150% of Medicare but consistent with commercial contract dynamics. Patients should be aware that hospitals often issue summary bills that obscure individual charges, so requesting a full itemized statement is crucial to identify any errors or unbundled codes before payment. If a balance bill arises from an out-of-network situation, the No Surprises Act may protect patients from paying the difference, and disputing unexpected charges in writing is the most effective way to ensure accurate billing.