CMS Price Transparency Data

CT scan, pelvis

Facility: Hospital for Special Surgery

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $857
Cash Discount Price: $1,218
vs. Medicare Baseline: 8.02x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Hospital for Special Surgery is $857. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,218. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 8.02x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$1,218

Average discount available for prompt cash payment at this facility.

Insurance Median

$857

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: $1,218 (1140%)

Insurance Median: $857 (802%)

Cash: $1,218 (1140% of Medicare)

Ins. Median: $857 (802% 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 802% of the Medicare baseline (a markup of 702%). 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
UnitedHealthcare	$39 - $1,183	37%
Fidelis	$41 - $43	38%
Metro Plus	$54 - $56	51%
Emblem	$55 - $73	51%
Blue Cross Blue Shield	$76 - $2,063	71%
Nyship	$83	78%
Horizon	$92	86%
Cigna	$115 - $1,485	108%
Aetna	$132 - $857	124%
Fidelis Essential [1323]	$318	298%
Apwu [1016]	$771 - $1,485	722%
Nalc [1090]	$771 - $1,485	722%
Qualcare [1101]	$771 - $1,485	722%
Wellfleet [1361]	$771 - $1,485	722%
Oxford [1096]	$823 - $857	771%
Affinity By Molina Health Plan [1005]	$857 - $1,124	802%
Christian Brothers [1034]	$857	802%
Connecticare [1039]	$857 - $1,744	802%
Emblem Health [1043]	$857 - $1,744	802%
Harvard Pilgrim [1057]	$857 - $1,183	802%
Medicare (plans)	$857	802%
Meritain Health [1085]	$857	802%
Nippon Life [1092]	$857	802%
Student Resources [1103]	$857 - $1,030	802%
Webtpa [1356]	$857	802%
Geha [1053]	$1,030	964%

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 $1,218.
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 Hospital for Special Surgery 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.