CMS Price Transparency Data

CT scan, pelvis

Facility: Southern Monterey County Memorial Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $39
Cash Discount Price: $35
vs. Medicare Baseline: 0.37x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Southern Monterey County Memorial Hospital is $39. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $35. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.37x the Medicare baseline. Located in 300 Canal Street, King City, CA.

Cash / Self-Pay

$35

Average discount available for prompt cash payment at this facility.

Insurance Median

$39

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: $35 (33%)

Insurance Median: $39 (37%)

Cash: $35 (33% of Medicare)

Ins. Median: $39 (37% 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.

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
Pcmi - All Plans	$34	32%
Pinnacle-All Plans	$34	32%
Blue Cross Blue Shield	$35	33%
Comm Health Ntwrk - All Plans	$37	35%
Monterey Bay Public-All Plans	$37	35%
Triwest - All Plans	$37	35%
Valley Hlth Plan - All Plans	$37	35%
Aetna	$39	37%
Blue Shield Exchange	$39	37%
Cigna	$39	37%
Corvel-All Plans	$39	37%
Multiplan/Phcs-All Plans	$39	37%
Coventry-All Plans	$41	38%
Healthnet Comml-All Other Plans	$41	38%
Provdr Ntwrk America - All Plans	$41	38%
UnitedHealthcare	$41	38%
Blue Shield-All Other Plans	$44	41%
Interplan - All Plans	$44	41%
Ccah- All Plans	$46	43%
Gold Coast Mcal-All Plans	$46	43%
Medi-Cal	$46	43%
United Ag Benefit-All Plans	$76	71%
Valenz-All Plans	$76	71%

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 $35.
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 Southern Monterey County Memorial Hospital 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.