CMS Price Transparency Data

CT scan, pelvis

Facility: Novant Health Forsyth Medical Center

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $1,140
Cash Discount Price: $1,030
vs. Medicare Baseline: 10.67x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Novant Health Forsyth Medical Center is $1,140. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,030. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 10.67x the Medicare baseline. Located in 3333 Silas Creek Parkway, Winston-Salem, NC.

Cash / Self-Pay

$1,030

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,140

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: $1,030 (964%)

Insurance Median: $1,140 (1067%)

Cash: $1,030 (964% of Medicare)

Ins. Median: $1,140 (1067% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 1067% of the Medicare baseline (a markup of 967%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$101 - $1,454	95%
Humana	$101 - $1,648	95%
Pace Of The Southern Piedmont	$101	95%
UnitedHealthcare	$101 - $1,424	95%
Aetna	$104 - $1,693	97%
Cigna	$104 - $1,257	97%
Liberty Health	$106	99%
Nc Department Of Public Safety	$203 - $393	190%
Carolina Complete	$301 - $393	282%
Amerihealth	$307 - $401	287%
Wellcare	$307 - $401	287%
Caresource North Carolina	$649 - $846	608%
Atlantic Corporation Dba Atlantic Packaging	$917 - $1,196	859%
Plotkin Health	$974 - $1,270	912%
Amps	$1,055 - $1,375	988%
Medcost	$1,380 - $1,989	1292%
Primary Physician Care	$1,428 - $1,862	1337%
Beechstreet	$1,461 - $1,904	1368%
Multiplan	$1,461 - $1,904	1368%
Phcs	$1,461 - $1,904	1368%
Employers Choice Network	$1,574 - $2,053	1474%
Three Rivers Provider Network	$1,574 - $2,053	1474%

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 $1,030.
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 Novant Health Forsyth Medical Center 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.