CT scan of pelvis with contrast dye

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

HC CT PELVIS W/CONTRAST

Sanford Health Plan rates for CPT 72193

The hospitals that file a Sanford Health Plan rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.

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193 hospital rates

#		Plans
1	Altru Hospital Devils Lake Devils Lake, ND facility · fee schedule · outpatient	1	$245.09	$209.27 – $280.91
2	Astera Health Wadena, MN fee schedule · inpatient	1	$364.56	$364.56 – $364.56
3	Astera Health Wadena, MN fee schedule · outpatient	1	$279.35	$279.35 – $279.35
4	Astera Health Wadena, MN percent of total billed charges · inpatientfrom % of charges	1	$2,234	$2,234 – $2,234
5	Astera Health Wadena, MN percent of total billed charges · outpatientfrom % of charges	1	$2,234	$2,234 – $2,234
6	CARRINGTON HEALTH CENTER Carrington, ND fee schedule · inpatient	1	$1,883	$1,883 – $1,883
7	CARRINGTON HEALTH CENTER Carrington, ND fee schedule · outpatient	1	$1,883	$1,883 – $1,883
8	Essentia Health Ada 201 9th St W Ada, MN facility · percent of total billed charges · inpatientfrom % of charges	2	$875.56	$853.08 – $898.03
9	Essentia Health Ada 201 9th St W Ada, MN facility · percent of total billed charges · outpatientfrom % of charges	2	$875.56	$853.08 – $898.03
10	Essentia Health Duluth Duluth, MN facility · case rate · outpatient	2	$315.23	$315.23 – $315.23
11	Essentia Health Duluth Duluth, MN facility · percent of total billed charges · inpatientfrom % of charges	2	$865.44	$843.22 – $887.65
12	Essentia Health Duluth Duluth, MN facility · percent of total billed charges · outpatientfrom % of charges	2	$865.44	$843.22 – $887.65
13	Essentia Health Fargo 3000 32nd Ave S Fargo, ND facility · case rate · outpatient	2	$315.23	$315.23 – $315.23
14	Essentia Health Fargo 3000 32nd Ave S Fargo, ND facility · percent of total billed charges · inpatientfrom % of charges	2	$865.44	$843.22 – $887.65
15	Essentia Health Fargo 3000 32nd Ave S Fargo, ND facility · percent of total billed charges · outpatientfrom % of charges	2	$865.44	$843.22 – $887.65
16	Essentia Health Fosston 900 Hilligoss Blvd SE Fosston, MN facility · percent of total billed charges · inpatientfrom % of charges	2	$875.56	$853.08 – $898.03
17	Essentia Health Fosston 900 Hilligoss Blvd SE Fosston, MN facility · percent of total billed charges · outpatientfrom % of charges	2	$875.56	$853.08 – $898.03
18	Essentia Health St. Joseph's Medical Center Brainerd, MN facility · percent of total billed charges · inpatientfrom % of charges	2	$865.44	$843.22 – $887.65
19	Essentia Health St. Joseph's Medical Center Brainerd, MN facility · percent of total billed charges · outpatientfrom % of charges	2	$865.44	$843.22 – $887.65
20	Essentia Health St. Mary's Children's Hospital Duluth, MN facility · case rate · outpatient	2	$315.23	$315.23 – $315.23
21	Essentia Health St. Mary's Children's Hospital Duluth, MN facility · percent of total billed charges · inpatientfrom % of charges	2	$865.44	$843.22 – $887.65
22	Essentia Health St. Mary's Children's Hospital Duluth, MN facility · percent of total billed charges · outpatientfrom % of charges	2	$865.44	$843.22 – $887.65
23	Essentia Health St. Mary's Medical Center Duluth, MN facility · case rate · outpatient	2	$315.23	$315.23 – $315.23
24	Essentia Health St. Mary's Medical Center Duluth, MN facility · percent of total billed charges · inpatientfrom % of charges	2	$865.44	$843.22 – $887.65
25	Essentia Health St. Mary's Medical Center Duluth, MN facility · percent of total billed charges · outpatientfrom % of charges	2	$865.44	$843.22 – $887.65

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