CMS Price Transparency Data

CT scan, pelvis

Facility: Bertrand Chaffee Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $85
Cash Discount Price: $440
vs. Medicare Baseline: 0.80x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Bertrand Chaffee Hospital is $85. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $440. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.80x the Medicare baseline. Located in 224 East Main Street, Springville, NY.

Cash / Self-Pay

$440

Average discount available for prompt cash payment at this facility.

Insurance Median

$85

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: $440 (412%)

Insurance Median: $85 (80%)

Cash: $440 (412% of Medicare)

Ins. Median: $85 (80% 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
Private Pay	$60 - $821	56%
Aetna	$70 - $966	66%
American Progressive Ins.	$70 - $966	66%
Cigna	$70 - $966	66%
Commercial / Misc	$70 - $966	66%
Global Excel Mgt	$70 - $966	66%
Guardian Life Ins. Co.	$70 - $966	66%
Mvp Commercial	$70 - $966	66%
No Amer Meritian Health	$70 - $966	66%
No-Fault	$70 - $966	66%
Iha Essential Plans	$82 - $91	77%
Iha Medisource	$82 - $91	77%
Comm Blue Essential	$85	80%
Community Blue	$85	80%
Community Care - Bc	$85	80%
Fidelis Care Of New York	$85	80%
Ghi Medical	$85	80%
Gowanda Correctional Fac	$85	80%
Medicaid / KanCare	$85	80%
Molina Essential Plan	$85	80%
Molina Heathcare Of Wny	$85	80%
Seneca Nation Health Dept	$85	80%
United Hc - Community Pln	$85	80%
United Hc Essential Plan	$85	80%
Univera Hc Myhealth	$85	80%
Univera Hc Myhealth+	$85 - $114	80%
Yourcare	$85	80%
Blue Cross Blue Shield	$91 - $98	85%
Senior Blue - Bc	$91	85%
Univera Essential Plans	$114	107%
Univera Hc Child Health+	$114	107%
Univera Plus Med	$114	107%
Iha Encompass 65	$127	119%
Iha	$131	123%
Iha Custom Coverage	$131	123%
Univera Senior Choice	$135	126%
Univera Healthcare	$161	151%
Fidelis Essential Plans	$318	298%

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 $440.
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 Bertrand Chaffee 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.