CMS Price Transparency Data

CT scan, pelvis

Facility: Davis County Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72192
  • Insurance Median: $883
  • Cash Discount Price: $1,603
  • vs. Medicare Baseline: 8.27x Medicare
The contracted insurance negotiated median rate for a CT scan, pelvis at Davis County Hospital is $883. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,603. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 8.27x the Medicare baseline. Located in 509 North Madison Street, Bloomfield, IA.
Cash / Self-Pay
$1,603

Average discount available for prompt cash payment at this facility.

Insurance Median
$883

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: $1,603 (1501%)
Insurance Median: $883 (827%)
Cash: $1,603 (1501% of Medicare)
Ins. Median: $883 (827% 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 827% of the Medicare baseline (a markup of 727%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Blue Cross Blue Shield $137 - $151 128%
Aetna $802 751%
Choicecare Mcr Adv $866 811%
Home State Hlth Exch - All Other Plans $866 811%
Home State Hlth Mcr $866 811%
Mt Carmel Hp-All Plans $866 811%
Tricare $866 811%
Amerigroup Mcr Adv-All Other Plans $883 827%
American Hp Mcr Adv-All Plans $909 851%
Home State Hlth Mcaid $962 901%
Iowa Total Care Mcaid-All Plans $981 918%
Molina Mcaid-All Plans $995 932%
Amerigroup Mcaid $1,000 936%
Midlands Choice - All Plans $1,122 1050%
Preferred Hlth Choices - All Plans $1,202 1125%
Choicecare Comm - All Other Plans $1,523 1426%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 509 North Madison Street, Bloomfield, IA 52537
  • CMS Rating: No CMS Rating
  • Ownership Type: Government - Local
  • Hospital Type: Critical Access Hospitals