CMS Price Transparency Data

CT scan, pelvis

Facility: Modoc Medical Center

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $1,371
Cash Discount Price: $1,580
vs. Medicare Baseline: 12.84x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Modoc Medical Center is $1,371. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,580. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 12.84x the Medicare baseline. Located in 1111 N Nagle Street, Alturas, CA.

Cash / Self-Pay

$1,580

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,371

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $1,580 (1479%)

Insurance Median: $1,371 (1284%)

Cash: $1,580 (1479% of Medicare)

Ins. Median: $1,371 (1284% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 1284% of the Medicare baseline (a markup of 1184%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Multiplan Wc	$101	95%
Ntwrks By Design Wc - All Plans	$106	99%
Integrated Hp Wc	$107	100%
Adv Med Mgmt - All Plans	$205	192%
Medi-Cal	$205	192%
Medi-Cal 7/1/24	$205	192%
Partnership Hp - All Plans	$716	670%
Blue Shield Mcr Adv	$855	800%
Blue Shield Va	$855	800%
UnitedHealthcare	$855 - $1,501	800%
Tricare	$900	843%
Healthnet Mcr Adv	$909	851%
Blue Cross Blue Shield	$1,299 - $1,443	1216%
Blue Shield Exch	$1,299	1216%
Blue Shield Comm - All Other Plans	$1,442	1350%
Carelon - All Plans	$1,443	1351%
Corvel - All Plans	$1,485	1390%
Aetna	$1,501	1405%
Coventry/First Health - All Plans	$1,501	1405%
Galaxy Health - All Plans	$1,501	1405%
Healthnet Comm - All Other Plans	$1,501	1405%
Hmn - All Plans	$1,501	1405%
Integrated Hp - All Other Plans	$1,501	1405%
Interplan - All Plans	$1,501	1405%
Multiplan - All Other Plans	$1,501	1405%
Superior Ca Ppo - All Plans	$1,501	1405%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $1,580.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72192.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Modoc Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72192.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.