CT scan, pelvis
Facility: Oakleaf Surgical Hospital
Billing Code: 72192 (CPT)
- CPT Billing Code: 72192
- Insurance Median: $104
- Cash Discount Price: $2,129
- vs. Medicare Baseline: 0.97x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $104 - $1,748 | 97% |
| Dean Health Plan | $104 | 97% |
| Group Health Cooperative Of Eau Claire | $104 | 97% |
| Healthpartners | $104 | 97% |
| Humana | $104 | 97% |
| Medica | $104 | 97% |
| Quartz Health Solutions | $104 | 97% |
| Security Health Plan Of Wi | $104 - $876 | 97% |
| Ucare Wi | $104 | 97% |
| UnitedHealthcare | $104 | 97% |
| Alliance | $518 | 485% |
Consumer Guidance & Cost Commentary
For this CT scan of the pelvis at Oakleaf Surgical Hospital in Altoona, WI, the cash median rate is $2,129. This facility is a physician-owned acute care hospital, and while the gross charge for this service is $2,366, the cash price remains the primary benchmark for self-pay patients. The Medicare benchmarking rate for this code is $106.81, which serves as the objective baseline for evaluating the markup of commercial rates. Although the state and county averages are not provided in this specific dataset, patients should note that commercial negotiated rates often average 200% to 300% of the Medicare rate, whereas fair pricing is typically defined as 120% to 150% of Medicare.
Insurance plans in this region have negotiated rates that vary significantly, with the lowest allowed amount being $104 and the highest reaching $1,748 depending on the payer. Notably, several plans including Blue Cross Blue Shield, Security Health Plan Of Wi, and Alliance have negotiated rates that exceed the cash price of $2,129, meaning patients with high-deductible plans might find paying cash upfront more cost-effective than using their insurance. If you choose to pay out-of-pocket, you should explicitly ask the hospital for "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can reduce the total cost. Additionally, because the No Surprises Act generally prohibits balance billing for emergency care and non-emergency services at in-network facilities, you can avoid unexpected bills by ensuring the facility is in your plan's network and requesting an itemized audit if discrepancies arise.