CT scan of pelvis with contrast dye at Gottlieb Memorial Hospital

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

Melrose Park, IL

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Pricing by billing methodology

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How this price compares nationally

Gottlieb Memorial Hospital’s median price of $316 is 33% below the median hospital's median price ($469), higher than 35% 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 Gottlieb Memorial Hospital

Negotiated rates from the hospital’s own file: 8 payers, 20 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 mmp/duals facility · fee schedule · outpatient	$172.58	$172.58	$172.58 – $172.58
2	Aetna medicare advantage facility · fee schedule · outpatient	$185.57	$185.57	$185.57 – $185.57
3	Humana medicare advantage facility · fee schedule · outpatient	$189.84	$189.84	$189.84 – $189.84
4	Cigna medicare advantage facility · fee schedule · outpatient	$191.14	$191.14	$191.14 – $191.14
5	Molina medicare advantage facility · fee schedule · outpatient	$194.85	$194.85	$194.85 – $194.85
6	WellCare medicare advantage facility · fee schedule · outpatient	$194.85	$194.85	$194.85 – $194.85
7	Oscar health exchange facility · fee schedule · outpatient	$204.13	$204.13	$204.13 – $204.13
8	Molina health exchange facility · fee schedule · outpatient	$231.96	$231.96	$231.96 – $231.96
9	Molina medicaid facility · case rate · outpatient	$315.57	$315.57	$315.57 – $315.57
10	Cigna hmo facility · other · outpatient	$519.00	$519.00	$519.00 – $519.00
11	Humana all products facility · fee schedule · outpatient	$913.83	$913.83	$913.83 – $913.83
12	UnitedHealthcare navigate core facility · other · outpatient	$1,065	$1,065	$1,065 – $1,065
13	UnitedHealthcare all products facility · other · outpatient	$1,161	$1,161	$1,161 – $1,161
14	Cigna ppo facility · other · outpatient	$1,170	$1,170	$1,170 – $1,170
15	Blue Cross Blue Shield blue choice facility · percent of total billed charges · outpatientfrom % of charges	$1,376	$1,376	$1,376 – $1,376
16	Blue Cross Blue Shield ppo facility · percent of total billed charges · outpatientfrom % of charges	$1,713	$1,713	$1,713 – $1,713
17	Blue Cross Blue Shield hmo facility · percent of total billed charges · outpatientfrom % of charges	$1,996	$1,996	$1,996 – $1,996
18	Blue Cross Blue Shield blue precision facility · percent of total billed charges · outpatientfrom % of charges	$2,073	$2,073	$2,073 – $2,073
19	Aetna fh-medical rental facility · percent of total billed charges · outpatientfrom % of charges	$2,175	$2,175	$2,175 – $2,175
20	Aetna all products facility · other · outpatient	$2,544	$2,544	$2,544 – $2,544

Last updated: Mar 31, 2026

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