CT scan, pelvis
Facility: Smith County Memorial Hospital
Billing Code: 72192 (CPT)
- CPT Billing Code: 72192
- Insurance Median: $660
- Cash Discount Price: $703
- vs. Medicare Baseline: 6.18x 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 618% of the Medicare baseline (a markup of 518%). 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 | $453 | 424% |
| Medicaid / KanCare | $492 - $703 | 461% |
| Multiplan-All Plans | $632 | 592% |
| Wppa-All Plans | $660 | 618% |
| Midlands Choice-All Plans | $667 | 624% |
| UnitedHealthcare | $667 | 624% |
| Health Partners Of Ks Ppo-All Plans | $667 | 624% |
Consumer Guidance & Cost Commentary
For the CT scan of the pelvis at Smith County Memorial Hospital in Smith Center, Kansas, the facility's cash price is $703.00, which matches the median amount paid by insurance plans. While the hospital is a government-owned Critical Access Hospital, its negotiated rates for Medicaid/KanCare plans range from $492 to $703, and other major payers like UnitedHealthcare and Multiplan-All Plans have fixed negotiated amounts of $667. It is important to note that cash-paying can sometimes be more cost-effective for patients with high-deductible plans if the insurance negotiated rate exceeds the cash price; however, in this specific case, the cash price is identical to the highest negotiated rate. Patients should verify their specific plan's deductible status before scheduling, as paying out-of-pocket may not result in savings if the insurance has already met its deductible or if the negotiated rate is lower than the cash price for their specific coverage tier.
The Medicare benchmark for this procedure is $106.81, which serves as the objective baseline for evaluating hospital pricing markups. Commercial negotiated rates for this service average between 200% and 300% of the Medicare rate, reflecting the administrative costs and contract dynamics of the insurance system. Since the facility's cash price of $703.00 is significantly higher than the Medicare benchmark, patients should consider requesting a prompt-pay discount, which typically ranges from 20% to 50% off the billed amount when paid in full upfront. Additionally, if a patient receives care from an out-of-network provider or encounters unexpected ancillary services, they may be subject to balance billing, though the No Surprises Act