CMS Price Transparency Data

CT scan, pelvis

Facility: UPMC Kane

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $353
Cash Discount Price: $559
vs. Medicare Baseline: 3.30x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at UPMC Kane is $353. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $559. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.30x the Medicare baseline. Located in 4372 Route 6, Kane, PA.

Cash / Self-Pay

$559

Average discount available for prompt cash payment at this facility.

Insurance Median

$353

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: $559 (523%)

Insurance Median: $353 (330%)

Cash: $559 (523% of Medicare)

Ins. Median: $353 (330% 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 330% of the Medicare baseline (a markup of 230%). 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	$104 - $747	97%
Blue Cross Blue Shield	$110 - $579	103%
Highmark Wholecare (Prev Gateway)	$113 - $595	106%
Aetna	$115 - $602	108%
UnitedHealthcare	$116 - $701	109%
Amerihealth Caritas	$119 - $625	111%
Geisinger	$156	146%
PA Health & Wellness	$192	180%
Cigna	$209 - $35,231	196%
Horizon Health Plan	$209 - $1,096	196%
Multiplan	$224 - $1,174	210%
Health Coalition Partners	$238 - $1,252	223%
Intergroup	$238 - $1,252	223%
Focus Healthcare	$283 - $1,487	265%
UPMC Work Partners	$632	592%

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 $559.
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 Kane 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.