CMS Price Transparency Data

CT scan, pelvis

Facility: Ira Davenport Memorial Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $1,459
Cash Discount Price: $1,605
vs. Medicare Baseline: 13.66x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Ira Davenport Memorial Hospital is $1,459. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,605. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 13.66x the Medicare baseline. Located in 7571 State Route 54, Bath, NY.

Cash / Self-Pay

$1,605

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,459

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: $1,605 (1503%)

Insurance Median: $1,459 (1366%)

Cash: $1,605 (1503% of Medicare)

Ins. Median: $1,459 (1366% 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 1366% of the Medicare baseline (a markup of 1266%). 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
Empire	$39 - $121	37%
Blue Cross Blue Shield	$112 - $8,046	105%
Fidelis	$112	105%
Humana	$126 - $2,387	118%
Tricare	$126	118%
Amerihealth Caritas Mcr Adv - All Plans	$127	119%
UnitedHealthcare	$1,217 - $2,785	1139%
Fidelis Care - Exchange - All Plans	$1,459	1366%
Geisinger - All Plans	$1,543	1445%
Cigna	$1,652	1547%
Mvp Health Plan - All Plans	$1,652	1547%
Independent Health - All Plans	$1,724	1614%
Upmc - All Plans	$1,830	1713%
Pomco Inc - All Plans	$1,910	1788%
Aetna	$1,989 - $2,367	1862%
Emblem Health - All Plans	$2,334	2185%
Emblem/Ghi	$2,451	2295%
Martins Point - All Plans	$2,652	2483%
Healthnow - All Plans	$8,736	8179%

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 $1,605.
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 Ira Davenport Memorial 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.