CMS Price Transparency Data

CT scan, pelvis

Facility: Cheshire Medical Center

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $262
Cash Discount Price: $426
vs. Medicare Baseline: 2.45x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Cheshire Medical Center is $262. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $426. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.45x the Medicare baseline. Located in 580 Court Street, Keene, NH.

Cash / Self-Pay

$426

Average discount available for prompt cash payment at this facility.

Insurance Median

$262

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: $426 (399%)

Insurance Median: $262 (245%)

Cash: $426 (399% of Medicare)

Ins. Median: $262 (245% 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 245% of the Medicare baseline (a markup of 145%). 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
Aetna	$51 - $1,747	48%
Ambetter / Centene	$54 - $99	51%
Blue Cross Blue Shield	$54 - $2,029	51%
Cigna	$54 - $1,264	51%
Martin'S Point Generations Advantage	$54 - $111	51%
Martin'S Point Health Care	$54 - $111	51%
Mvp	$54 - $1,264	51%
UnitedHealthcare	$54 - $1,938	51%
Wellcare Health Plans	$54 - $111	51%
Wellsense Health Plan	$54 - $352	51%
Amerihealth Caritas Nh	$65 - $313	61%
Granite State Health Plan	$89 - $427	83%
Mass General Brigham Health Plan	$106 - $2,554	99%
Harvard Pilgrim Health Care Of Ne	$113 - $1,161	106%
Tufts Health Plan	$151 - $1,630	141%
Maine Community Health Options	$238 - $1,149	223%
First Health/Hcvm	$450 - $2,171	421%
Phcs	$477 - $2,299	447%

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 $426.
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 Cheshire 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.