CT scan, pelvis
Facility: William Newton Hospital
Billing Code: 72192 (CPT)
- CPT Billing Code: 72192
- Insurance Median: $437
- Cash Discount Price: $1,158
- vs. Medicare Baseline: 4.09x 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 409% of the Medicare baseline (a markup of 309%). 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 |
|---|---|---|
| Triwest- All Plans | $405 | 379% |
| UnitedHealthcare | $417 - $1,043 | 390% |
| Ambetter / Centene | $417 - $1,158 | 390% |
| Blue Cross Blue Shield | $417 - $456 | 390% |
| Providrs Care Nexus | $709 | 664% |
| Providrs Care - All Other Plans | $811 | 759% |
Consumer Guidance & Cost Commentary
For the CPT code 72192 (CT scan, pelvis) at William Newton Hospital in Winfield, KS, the cash price is $1,158, which matches the facility's gross charge and the median cash payment. This rate is significantly higher than the state average, as indicated by a 4.1x markup compared to Medicare's benchmark of $106.81. While the hospital is a Critical Access Hospital with a government-local ownership structure, patients should be aware that commercial insurance negotiated rates vary widely; for example, UnitedHealthcare plans range from $417 to $1,043, while Ambetter/Centene plans range from $417 to $1,158. Because the cash price is lower than the maximum negotiated rates for some payers, paying out-of-pocket upfront could result in immediate savings, provided the patient's insurance deductible has been met.
To maximize potential savings, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as these facilities often offer 20% to 50% reductions for upfront payment to bypass administrative claim processing costs. It is crucial to avoid automatic claims submission, which can void any cash discount agreement, and instead sign a waiver of insurance submission if paying in full. Additionally, patients should request a detailed, itemized billing audit rather than accepting a summary bill, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that can be corrected. Given the No Surprises Act protections against balance billing for out-of-network services at in-network facilities, patients should verify their plan's specific allowed amounts and deductible status before proceeding