CT scan, pelvis
Facility: Girard Medical Center
Billing Code: 72192 (CPT)
- CPT Billing Code: 72192
- Insurance Median: $805
- Cash Discount Price: $1,380
- vs. Medicare Baseline: 7.54x 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 754% of the Medicare baseline (a markup of 654%). 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 - $805 | 449% |
| Kansas Superior Select-All Plans | $805 | 754% |
| UnitedHealthcare | $805 - $2,185 | 754% |
| Ambetter / Centene | $805 | 754% |
| Aetna | $805 - $4,025 | 754% |
| Humana | $805 | 754% |
| Medicare (plans) | $805 | 754% |
| Multiplan-All Plans | $2,128 | 1992% |
| Uhhis-All Plans | $2,185 | 2046% |
Consumer Guidance & Cost Commentary
For the CT scan of the pelvis at Girard Medical Center in Girard, KS, the facility's cash median price is $1,380, while the median negotiated rate paid by insurance plans is $805. This service is provided by a Critical Access Hospital owned by a government hospital district. While the cash price is higher than the negotiated rate, patients with high-deductible plans may find paying cash directly more cost-effective if their insurance allowed amount exceeds the cash price, as the out-of-pocket cost could be lower than the full negotiated fee. It is important to note that commercial rates often include administrative overhead, and comparing these directly to the state average provides a clearer picture of value than looking solely at the hospital's gross charges.
The data indicates that Medicare reimbursement for this procedure is $106.81, which serves as a baseline for evaluating the facility's pricing markup. Commercial negotiated rates for this service average between 200% and 300% of the Medicare rate, though fair pricing is typically defined as 120% to 150% of Medicare. Patients should be aware that balance billing, where a patient is billed for the difference between the provider's full charge and the insurance allowed amount, is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act. To ensure transparency and avoid unexpected costs, consumers are encouraged to request an itemized billing audit to verify that all charges correspond to services actually rendered and to inquire about prompt-pay discounts that may reduce the final bill if paid in full upfront.