CMS Price Transparency Data

CT scan, pelvis

Facility: Porter Hospital Inc

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $179
Cash Discount Price: $1,302
vs. Medicare Baseline: 1.68x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Porter Hospital Inc is $179. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,302. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.68x the Medicare baseline. Located in 115 Porter Drive, Middlebury, VT.

Cash / Self-Pay

$1,302

Average discount available for prompt cash payment at this facility.

Insurance Median

$179

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: $1,302 (1219%)

Insurance Median: $179 (168%)

Cash: $1,302 (1219% of Medicare)

Ins. Median: $179 (168% 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
UnitedHealthcare	$34 - $2,310	32%
Mvp	$41 - $2,174	38%
Fidelis Care	$44 - $987	41%
Humana	$46 - $101	43%
Capital District Physicians' Health Plan	$48 - $1,946	45%
Aetna	$49 - $1,097	46%
Martins Point	$49 - $1,097	46%
Veterans Affairs Community Care Network	$49 - $1,097	46%
Veterans Choice	$49 - $1,097	46%
Blue Cross Blue Shield	$56 - $2,198	52%
Harvard Pilgrim	$57 - $1,866	53%
Coventry	$63 - $2,053	59%
Cigna	$71 - $2,122	66%
Wellpath	$148 - $1,283	139%
Medical Corporation	$256 - $2,216	240%
Multiplan	$256 - $2,216	240%

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 $1,302.
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 Porter 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.