CT scan of pelvis with and without contrast dye at Samaritan 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

PR Cta Pelvis W/O &/or W/Contrast|PROFESSIONAL COMPONENT

Troy, NY

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How this price compares nationally

Samaritan Hospital’s median price of $504 is 6% above the median hospital's median price ($475), higher than 51% of the 2,436 hospitals reporting CPT 72191. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting CPT 72191 at Samaritan Hospital

Negotiated rates from the hospital’s own file: 34 payers, 107 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	Humana tricare professional · fee schedule · inpatient	$158	$158	$81	51%	—	$77 – $239
2	Humana tricare professional · fee schedule · outpatient	$158	$158	$81	51%	—	$77 – $239
3	Tricare tricare professional · fee schedule · inpatient	$158	$158	$81	51%	—	$77 – $239
4	Tricare tricare professional · fee schedule · outpatient	$158	$158	$81	51%	—	$77 – $239
5	UnitedHealthcare united healthcare medicaid harp chip facility · fee schedule · both	$211	$211	—	—	—	$211 – $211
6	Anthem empire bcbs medicare advantage facility · other · both	$215	$215	—	—	—	$215 – $215
7	UnitedHealthcare united healthcare medicare advantage facility · other · both	$223	$223	—	—	—	$223 – $223
8	Aetna aetna medicare advantage facility · other · both	$232	$232	—	—	—	$232 – $232
9	WellCare wellcare medicare advantage facility · other · both	$239	$239	—	—	—	$239 – $239
10	Excellus blue shield of ne new york medicare adv facility · other · both	$241	$241	—	—	—	$241 – $241
11	Highmark blue shield of ne new york medicare adv facility · other · both	$241	$241	—	—	—	$241 – $241
12	Anthem empire medicaid facility · fee schedule · both	$272	$272	—	—	—	$272 – $272
13	Excellus empire medicaid facility · fee schedule · both	$272	$272	—	—	—	$272 – $272
14	WellCare wellcare ep 1&2 medicaid facility · other · both	$350	$350	—	—	—	$350 – $350
15	Aetna pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$446	$446	$225	50%	—	$221 – $670
16	Ambetter pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$446	$446	$225	50%	—	$221 – $670
17	Amerihealth Caritas pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$446	$446	$225	50%	—	$221 – $670
18	Anthem pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$446	$446	$225	50%	—	$221 – $670
19	Blue Cross Blue Shield pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$446	$446	$225	50%	—	$221 – $670
20	Carefirst pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$446	$446	$225	50%	—	$221 – $670
21	Caresource pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$446	$446	$225	50%	—	$221 – $670
22	Cigna pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$446	$446	$225	50%	—	$221 – $670
23	Clover pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$446	$446	$225	50%	—	$221 – $670
24	Devoted pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$446	$446	$225	50%	—	$221 – $670
25	Excellus pb xr 100% default professional · percent of total billed charges · inpatientfrom % of charges	$446	$446	$225	50%	—	$221 – $670

Page 1 of 5 · 107 rates

Last updated: Mar 31, 2026

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