CT scan, pelvis
Facility: Hodgeman County Health Center
Billing Code: 72192 (CPT)
- CPT Billing Code: 72192
- Insurance Median: $1,192
- Cash Discount Price: $1,354
- vs. Medicare Baseline: 11.16x 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 1116% of the Medicare baseline (a markup of 1016%). 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 | $435 - $458 | 407% |
| Humana | $1,084 | 1015% |
| Triwest - All Plans | $1,084 | 1015% |
| UnitedHealthcare | $1,084 - $1,608 | 1015% |
| Medicaid / KanCare | $1,084 - $1,693 | 1015% |
| Aetna | $1,354 | 1268% |
| First Health - All Plans | $1,524 | 1427% |
| Wppa (Provdrscare) - All Plans | $1,608 | 1505% |
| Health Partners - All Plans | $1,608 | 1505% |
Consumer Guidance & Cost Commentary
For the CT scan of the pelvis (CPT 72192) at Hodgeman County Health Center in Jetmore, Kansas, the cash price is $1,354, which aligns with the state average for this service. While commercial insurance plans like Humana and Triwest have a negotiated rate of $1,084, other payers such as UnitedHealthcare and Medicaid/KanCare have negotiated ranges extending up to $1,693. This demonstrates that in-network coverage does not guarantee the lowest cost; in some cases, paying cash directly can be cheaper than the insurance negotiated rate, particularly for patients with high deductibles. Because the facility is a Critical Access Hospital owned by the local government, patients should explicitly ask about self-pay or prompt-pay discounts before scheduling, as these upfront incentives can significantly reduce the final bill.
The Medicare benchmark for this procedure is $106.81, which serves as the objective baseline for evaluating pricing fairness. The facility's cash rate of $1,354 represents a significant markup compared to the federal government's cost-based reimbursement, a common characteristic of commercial pricing structures. To ensure you are not overcharged, request a full itemized bill that breaks down every CPT code and charge, as summary bills often hide unbundled fees or services not rendered. If you receive a balance bill from an out-of-network provider at this in-network facility, you may be protected under the No Surprises Act, which prohibits providers from charging you the difference between their full rate and your insurance allowed amount for emergency or non-emergency services. Always dispute any unexpected balance bills in writing rather than paying immediately to avoid credit damage.