CMS Price Transparency Data

CT scan, pelvis

Facility: T J Samson Community Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $129
Cash Discount Price: $539
vs. Medicare Baseline: 1.21x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at T J Samson Community Hospital is $129. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $539. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.21x the Medicare baseline. Located in 1301 North Race Street, Glasgow, KY.

Cash / Self-Pay

$539

Average discount available for prompt cash payment at this facility.

Insurance Median

$129

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $539 (505%)

Insurance Median: $129 (121%)

Cash: $539 (505% of Medicare)

Ins. Median: $129 (121% of 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.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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	$48 - $1,299	45%
Center Care Select - All Plans	$48 - $1,299	45%
Signature Health - All Plans	$48 - $107	45%
Wellcare Mcr Adv - All Other Plans	$48 - $106	45%
Molina Mcr Adv	$49 - $108	46%
Devoted Mcr Adv - All Plans	$51 - $112	48%
Humana	$51 - $206	48%
Caresource - All Plans	$63 - $159	59%
Molina Marketplace - All Other Plans	$63 - $159	59%
Wellcare Mcaid	$104 - $129	97%
Aetna	$129 - $206	121%
Molina Mcaid	$133 - $212	125%
UnitedHealthcare	$1,187	1111%
Phcs/Multiplan - All Plans	$1,436	1344%
First Health - All Plans	$1,452	1359%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $539.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72192.

Insurance In-Network Protection Plan

Contact your insurance company to confirm T J Samson Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72192.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.