CT scan, pelvis
Facility: Aurora Medical Center
Billing Code: 72192 (CPT)
- CPT Billing Code: 72192
- Insurance Median: $1,014
- Cash Discount Price: $1,470
- vs. Medicare Baseline: 9.49x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 949% of the Medicare baseline (a markup of 849%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Aurora Caregiver | $475 | 445% |
| UnitedHealthcare | $538 - $2,475 | 504% |
| Blue Cross Blue Shield | $556 - $2,499 | 521% |
| Healthpartners | $796 - $2,205 | 745% |
| Molina Exchange | $796 | 745% |
| Common Ground | $812 | 760% |
| Centivo | $820 | 768% |
| Aetna | $836 - $2,428 | 783% |
| Health Payment Systems | $875 | 819% |
| Quartz One | $900 | 843% |
| Everpointe Elite | $983 | 920% |
| Quartz Group | $1,000 | 936% |
| Hs Technology | $1,014 | 949% |
| Wisconsin Physician Service | $1,128 - $1,187 | 1056% |
| Trilogy | $1,170 | 1095% |
| Cigna | $1,700 - $2,487 | 1592% |
| Health Eos Plus | $1,764 | 1652% |
| Health Eos | $2,352 | 2202% |
Consumer Guidance & Cost Commentary
For the CT scan of the pelvis at Aurora Medical Center in Grafton, WI, the facility's cash payment rate of $1,470 is significantly higher than the Medicare benchmark of $106.81, which serves as the federal baseline for this service. While the facility lists a gross charge of $2,940, commercial insurance plans typically pay negotiated rates that vary widely; for instance, UnitedHealthcare plans pay between $538 and $2,475, while Molina Exchange pays a flat $796. Because the cash rate of $1,470 is lower than the high-end negotiated rates for many major payers like UnitedHealthcare and Cigna, patients with high-deductible plans may find paying cash upfront is the most cost-effective option if they have not yet met their deductible.
Patients should verify their specific plan's negotiated rate before scheduling, as some carriers like Common Ground and Quartz One pay fixed amounts of $812 and $1,000 respectively, which are lower than the cash price. It is important to note that the facility is a voluntary non-profit acute care hospital with a five-star rating, and while the data does not provide explicit state or county average comparisons for this specific procedure, the wide variance in payer rates—from $475 for Aurora Caregiver to $2,487 for Cigna—highlights the necessity of checking your specific coverage details. To potentially reduce costs further, patients should inquire directly with the hospital about self-pay or prompt-pay discounts, which can offer fee reductions for upfront payment, and request a waiver of automatic insurance submission to ensure they are billed at the agreed cash rate rather than