CT scan of pelvis with contrast dye at Mercy Hospital Jefferson

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 Cont

Festus, MO

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How this price compares nationally

Mercy Hospital Jefferson’s median price of $291 is 38% below the median hospital's median price ($469), higher than 31% 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 Mercy Hospital Jefferson

Negotiated rates from the hospital’s own file: 17 payers, 40 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	Molina hb wash jefn linc samc molina healthchoice of il medicaid new 040125 facility · percent of total billed charges · outpatientfrom % of charges	$137.28	$137.28	$137.28 – $137.28
2	Medicaid hb jefn mo medicaid facility · fee schedule · outpatient	$151.76	$151.76	$151.76 – $151.76
3	Aetna hb jefn aetna/coventry mgd medicare facility · other · outpatient	$172.35	$172.35	$172.35 – $172.35
4	Aetna hb jefn coventry medicare facility · other · outpatient	$172.35	$172.35	$172.35 – $172.35
5	Blue Cross Blue Shield hb jefn medicare and 100% managed medicare facility · other · outpatient	$172.35	$172.35	$172.35 – $172.35
6	Humana hb jefn humana medicare w/seq ip 97% op 100% new 010124 facility · other · outpatient	$172.35	$172.35	$172.35 – $172.35
7	Humana hb jefn medicare and 100% managed medicare facility · other · outpatient	$172.35	$172.35	$172.35 – $172.35
8	Medica hb jefn medicare and 100% managed medicare facility · other · outpatient	$172.35	$172.35	$172.35 – $172.35
9	Medicare hb jefn medicare and 100% managed medicare facility · other · outpatient	$172.35	$172.35	$172.35 – $172.35
10	Tricare hb jefn tricare - healthnet west facility · other · outpatient	$172.35	$172.35	$172.35 – $172.35
11	UnitedHealthcare hb jefn medicare and 100% managed medicare facility · other · outpatient	$172.35	$172.35	$172.35 – $172.35
12	WellCare hb jefn medicare and 100% managed medicare facility · other · outpatient	$172.35	$172.35	$172.35 – $172.35
13	Cigna hb jefn cigna managed medicare 010122 103% w/seq 010123 102% w/seq facility · other · outpatient	$175.79	$175.79	$175.79 – $175.79
14	WellCare hb jefn wellcare harmony mcr 103% facility · other · outpatient	$177.62	$177.62	$177.62 – $177.62
15	Devoted hb jefn devoted health medicare advantage 104% w/seq facility · other · outpatient	$179.23	$179.23	$179.23 – $179.23
16	UnitedHealthcare hb jefn uhc managed medicaid facility · fee schedule · outpatient	$197.29	$197.29	$197.29 – $197.29
17	UnitedHealthcare hb jefn uhc core new 100121 facility · fee schedule · outpatient	$199.57	$199.57	$199.57 – $199.57
18	Aetna hb wash jefn aetna commercial new 070123 facility · fee schedule · outpatient	$216.41	$216.41	$216.41 – $216.41
19	Optum hb jefn uhc hmo ppo all payer facility · fee schedule · outpatient	$227.58	$227.58	$227.58 – $227.58
20	UnitedHealthcare hb jefn uhc compass/exchange facility · fee schedule · outpatient	$227.58	$227.58	$227.58 – $227.58
21	UnitedHealthcare hb jefn uhc hmo ppo all payer facility · fee schedule · outpatient	$227.58	$227.58	$227.58 – $227.58
22	Blue Cross Blue Shield hb jefn missouri care health plan/healthy blue facility · fee schedule · outpatient	$250.40	$250.40	$250.40 – $250.40
23	Medica hb jefn medica exchange facility · per diem · outpatient	$261.00	$261.00	$261.00 – $261.00
24	Blue Cross Blue Shield hb jefn anthem pathway/exchange eff 011520 facility · fee schedule · outpatient	$272.82	$272.82	$272.82 – $272.82
25	Blue Cross Blue Shield hb jefn anthem blue preferred eff 011520 facility · fee schedule · outpatient	$298.88	$298.88	$298.88 – $298.88

Page 1 of 2 · 40 rates

Last updated: Jun 10, 2026

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