CMS Price Transparency Data

CT scan, pelvis

Facility: St Mary Medical Center

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $204
Cash Discount Price: $1,431
vs. Medicare Baseline: 1.91x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at St Mary Medical Center is $204. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,431. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.91x the Medicare baseline. Located in Langhorne-Newtown Rd, Langhorne, PA.

Cash / Self-Pay

$1,431

Average discount available for prompt cash payment at this facility.

Insurance Median

$204

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: $1,431 (1340%)

Insurance Median: $204 (191%)

Cash: $1,431 (1340% of Medicare)

Ins. Median: $204 (191% 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
Medicaid / KanCare	$90 - $270	84%
UnitedHealthcare	$111 - $1,065	104%
Blue Cross Blue Shield	$113	106%
Cigna	$114 - $1,701	107%
Align Senior Care	$115	108%
Medicare (plans)	$116 - $203	109%
Aetna	$119 - $1,959	111%
Health America Advantra	$135	126%
Ambetter / Centene	$201	188%
Oscar	$203	190%
Prime Healthcare	$203	190%
Jefferson Health Plan Commercial	$205	192%
Homestead Health Plans Woods Center	$220	206%
Pace-Trinity Health	$242	227%
Group Pension Administrators	$254	238%
Reedman Toll	$254	238%
Keystone First	$270	253%
Keystone First Chip	$270	253%
Blue Shield - Pa (Highmark)	$305	286%
Geha	$898	841%
Upmc Health Plan	$1,701	1593%
Webtpa	$1,701	1593%
Meritain	$1,959	1834%
Multiplan	$1,981	1855%
Prime Health Services	$1,981	1855%
Galaxy Health Network	$2,091	1958%
Three Rivers Provider Network	$2,091	1958%

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 $1,431.
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 St Mary Medical Center 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.