CMS Price Transparency Data

CT scan, pelvis

Facility: UPMC Horizon

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $1,150
Cash Discount Price: $1,789
vs. Medicare Baseline: 10.77x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at UPMC Horizon is $1,150. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,789. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 10.77x the Medicare baseline. Located in 110 North Main Street, Greenville, PA.

Cash / Self-Pay

$1,789

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,150

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: $1,789 (1675%)

Insurance Median: $1,150 (1077%)

Cash: $1,789 (1675% of Medicare)

Ins. Median: $1,150 (1077% 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 1077% of the Medicare baseline (a markup of 977%). 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
Upmc Health Plan	$91 - $1,014	85%
Aetna	$104 - $1,789	97%
UnitedHealthcare	$106 - $1,193	99%
Amerihealth Caritas	$109 - $176	102%
Cigna	$109 - $1,193	102%
Highmark Wholecare (Prev Gateway)	$109 - $167	102%
Pa Health & Wellness	$109 - $192	102%
Geisinger	$156	146%
Health Partners Plans (Jefferson Health Plan)	$170	159%
Blue Cross Blue Shield	$190 - $1,360	178%
Upmc Work Partners	$642	601%
Intergroup	$1,938	1814%
Coventry/First Health	$1,968	1843%
Health Coalition Partners	$2,087	1954%
Private Health Care Systems	$2,386	2234%
Prime Net	$2,445	2289%
Humana	$2,535	2373%

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 $1,789.
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 UPMC Horizon 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.