CT scan of pelvis with contrast dye at Forsyth Memorial Hospital, Inc.

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

CT PELVIS W CONTRAST

Winston-Salem, NC

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How this price compares nationally

Forsyth Memorial Hospital, Inc.’s median price of $388 is 17% below the median hospital's median price ($469), higher than 41% of the 2,597 hospitals reporting CPT 72193. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting CPT 72193 at Forsyth Memorial Hospital, Inc.

Negotiated rates from the hospital’s own file: 11 payers, 28 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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1	Blue Cross Blue Shield blue medicare fee schedule · outpatient	$170.11	$170.11	$170.11 – $170.11
2	Humana medicare fee schedule · outpatient	$170.11	$170.11	$170.11 – $170.11
3	UnitedHealthcare medicare fee schedule · outpatient	$170.11	$170.11	$170.11 – $170.11
4	Aetna medicare fee schedule · outpatient	$174.36	$174.36	$174.36 – $174.36
5	Cigna healthspring fee schedule · outpatient	$175.21	$175.21	$175.21 – $175.21
6	Blue Cross Blue Shield healthy blue medicaid fee schedule · outpatient	$388.27	$388.27	$388.27 – $388.27
7	UnitedHealthcare medicaid fee schedule · outpatient	$388.27	$388.27	$388.27 – $388.27
8	WellCare medicaid fee schedule · outpatient	$388.27	$388.27	$388.27 – $388.27
9	Cigna aca fee schedule · outpatient	$793.35	$793.35	$793.35 – $793.35
10	Caresource qualified health plan fee schedule · outpatient	$820.00	$820.00	$820.00 – $820.00
11	Blue Cross Blue Shield blue home fee schedule · outpatient	$1,070	$1,070	$1,070 – $1,070
12	Blue Cross Blue Shield blue value fee schedule · outpatient	$1,107	$1,107	$1,107 – $1,107
13	Cigna commercial fee schedule · outpatient	$1,218	$1,218	$1,218 – $1,218
14	Aetna commercial fee schedule · outpatient	$1,263	$1,263	$1,263 – $1,263
15	UnitedHealthcare all payer fee schedule · outpatient	$1,380	$1,380	$1,380 – $1,380
16	Blue Cross Blue Shield hmo fee schedule · outpatient	$1,408	$1,408	$1,408 – $1,408
17	Blue Cross Blue Shield ppo fee schedule · outpatient	$1,408	$1,408	$1,408 – $1,408
18	Humana commercial fee schedule · outpatient	$1,597	$1,597	$1,597 – $1,597
19	Aetna aca fee schedule · outpatient	$1,640	$1,640	$1,640 – $1,640
20	Aetna first health fee schedule · outpatient	$1,640	$1,640	$1,640 – $1,640
21	Aetna non-par products of apcn fee schedule · outpatient	$1,640	$1,640	$1,640 – $1,640
22	Aetna rental network products fee schedule · outpatient	$1,640	$1,640	$1,640 – $1,640
23	Aetna whole health non-multitier fee schedule · outpatient	$1,640	$1,640	$1,640 – $1,640
24	Medcost mbs fee schedule · outpatient	$1,743	$1,743	$1,743 – $1,743
25	Beechstreet commercial fee schedule · outpatient	$1,845	$1,845	$1,845 – $1,845

Page 1 of 2 · 28 rates

Last updated: Mar 30, 2026

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