CMS Price Transparency Data

CT scan, pelvis

Facility: Westfield Memorial Hospital Inc

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $111
Cash Discount Price: $902
vs. Medicare Baseline: 1.04x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Westfield Memorial Hospital Inc is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $902. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.04x the Medicare baseline. Located in 189 E Main St, Westfield, NY.

Cash / Self-Pay

$902

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

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: $902 (844%)

Insurance Median: $111 (104%)

Cash: $902 (844% of Medicare)

Ins. Median: $111 (104% 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
Univera	$42 - $161	39%
Amerihealth	$47 - $186	44%
Pennsylvania Health And Wellness	$59 - $169	55%
Highmark	$60 - $209	56%
Geisinger	$65 - $180	61%
UnitedHealthcare	$65 - $268	61%
Cigna	$82 - $212	77%
Jefferson Health Plans	$103 - $172	96%
American Health Plans	$126	118%
Life Pittsburgh	$126	118%
Martin'S Point	$126	118%
Medicare (plans)	$130	122%
Aetna	$131 - $242	123%
Humana	$133	125%
Molina	$137	128%

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 $902.
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 Westfield Memorial Hospital Inc 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.