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.
Original text from hospital filings
Ct pelvis w/dye
Lebanon, NH
See all hospitals reporting CPT 72193 →Price type
Mary Hitchcock Memorial Hospital’s median price of $333 is 29% below the median hospital's median price ($469), higher than 36% of the 2,597 hospitals reporting CPT 72193. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 10 payers, 102 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 | Anthem anthem - medicare advantage - dhp professional · fee schedule · outpatient | $73.99 | $73.99 | $53.02 – $94.96 |
| 2 | Bcbs Vt bcbs of vermont - medicare advantage - dhp professional · fee schedule · outpatient | $73.99 | $73.99 | $53.02 – $94.96 |
| 3 | UnitedHealthcare uhc - medicare advantage - dhp professional · fee schedule · outpatient | $73.99 | $73.99 | $53.02 – $94.96 |
| 4 | UnitedHealthcare uhc - va community care network - dhpn professional · fee schedule · outpatient | $73.99 | $73.99 | $53.02 – $94.96 |
| 5 | Aetna aetna medicare advantage - dhp professional · fee schedule · outpatient | $76.21 | $76.21 | $54.61 – $97.80 |
| 6 | Cigna cigna medicare advantage - dhp professional · fee schedule · outpatient | $76.21 | $76.21 | $54.61 – $97.80 |
| 7 | WellCare wellcare - medicare advantage - dhp professional · fee schedule · outpatient | $76.95 | $76.95 | $55.14 – $98.75 |
| 8 | Ambetter ambetter commercial - exchange behavioral health - dhp professional · fee schedule · outpatient | $77.69 | $77.69 | $55.67 – $99.70 |
| 9 | Amerihealth Caritas amerihealth caritas - nh managed medicaid - dhp professional · fee schedule · outpatient | $99.17 | $99.17 | $29.19 – $169.14 |
| 10 | Amerihealth Caritas amerihealth caritas - nh managed medicaid professional · percent of total billed charges · outpatientfrom % of charges | $133.13 | $133.13 | $133.13 – $133.13 |
| 11 | Ambetter ambetter commercial - exchange - dhpn professional · fee schedule · outpatient | $134.63 | $134.63 | $94.96 – $174.30 |
| 12 | UnitedHealthcare uhc - tiered freedom plan professional · fee schedule · outpatient | $137.28 | $137.28 | $64.60 – $209.95 |
| 13 | UnitedHealthcare uhc - freedom plan - dhp professional · fee schedule · outpatient | $152.53 | $152.53 | $71.77 – $233.28 |
| 14 | Amerihealth Caritas amerihealth caritas - nh managed medicaid professional · fee schedule · outpatient | $163.69 | $163.69 | $163.69 – $163.69 |
| 15 | Anthem anthem - medicare advantage facility · case rate · outpatient | $199.21 | $199.21 | $199.21 – $199.21 |
| 16 | Bcbs Vt bcbs of vermont - medicare advantage facility · case rate · outpatient | $199.21 | $199.21 | $199.21 – $199.21 |
| 17 | UnitedHealthcare uhc - medicare advantage facility · case rate · outpatient | $199.21 | $199.21 | $199.21 – $199.21 |
| 18 | UnitedHealthcare uhc - va community care network facility · case rate · outpatient | $199.21 | $199.21 | $199.21 – $199.21 |
| 19 | Aetna aetna medicare advantage facility · case rate · outpatient | $205.19 | $205.19 | $205.19 – $205.19 |
| 20 | Cigna cigna medicare advantage facility · case rate · outpatient | $205.19 | $205.19 | $205.19 – $205.19 |
| 21 | WellCare wellcare - medicare advantage facility · case rate · outpatient | $207.18 | $207.18 | $207.18 – $207.18 |
| 22 | UnitedHealthcare uhc - va community care network - dhps professional · fee schedule · outpatient | $229.20 | $229.20 | $229.20 – $229.20 |
| 23 | Ambetter ambetter commercial - exchange - dhps professional · fee schedule · outpatient | $271.82 | $271.82 | $125.76 – $417.87 |
| 24 | Ambetter ambetter commercial - exchange behavioral health facility · case rate · outpatient | $274.71 | $274.71 | $274.71 – $274.71 |
| 25 | Cigna cigna hmo-pos professional · fee schedule · outpatient | $291.83 | $291.83 | $137.32 – $446.34 |
Last updated: Jan 1, 2026
See CT scan of pelvis with contrast dye pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.