CMS Price Transparency Data

CT scan, pelvis

Facility: Virginia Gay Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $810
Cash Discount Price: $1,342
vs. Medicare Baseline: 7.58x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Virginia Gay Hospital is $810. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,342. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.58x the Medicare baseline. Located in 502 North 9Th Avenue, Vinton, IA.

Cash / Self-Pay

$1,342

Average discount available for prompt cash payment at this facility.

Insurance Median

$810

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: $1,342 (1256%)

Insurance Median: $810 (758%)

Cash: $1,342 (1256% of Medicare)

Ins. Median: $810 (758% 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 758% of the Medicare baseline (a markup of 658%). 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
Medicaid / KanCare	$107 - $729	100%
Aetna	$159	149%
Wellmark Hmo	$480	449%
Wellmark Ppo-All Other Plans	$529	495%
UnitedHealthcare	$562 - $810	526%
Va Ccn-All Plans	$611 - $630	572%
Health Alliance Mcr Adv	$644 - $664	603%
Medical Associates-All Plans	$1,239 - $1,276	1160%
Cedar Valley Community Healthcare-All Plans	$1,301 - $1,340	1218%
Humana	$1,322 - $1,362	1238%
Health Partners-All Plans	$1,404 - $1,447	1314%
Healthsmart-All Plans	$1,404 - $1,447	1314%
Corvel-All Plans	$1,536 - $1,583	1438%
Health Alliance-All Other Plans	$1,569 - $1,617	1469%

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 $1,342.
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 Virginia Gay 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.