CMS Price Transparency Data

CT scan, pelvis

Facility: Mercyone Dyersville Medical Center

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72192
  • Insurance Median: $1,642
  • Cash Discount Price: $1,291
  • vs. Medicare Baseline: 15.37x Medicare
The contracted insurance negotiated median rate for a CT scan, pelvis at Mercyone Dyersville Medical Center is $1,642. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,291. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 15.37x the Medicare baseline. Located in 1111 3Rd Street Sw, Dyersville, IA.
Cash / Self-Pay
$1,291

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,642

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: $1,291 (1209%)
Insurance Median: $1,642 (1537%)
Cash: $1,291 (1209% of Medicare)
Ins. Median: $1,642 (1537% 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 1537% of the Medicare baseline (a markup of 1437%). 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
Health Choices $751 703%
Blue Cross Blue Shield $1,101 1031%
Medicare (plans) $1,123 - $1,226 1051%
UnitedHealthcare $1,179 - $1,390 1104%
The Alliance $1,208 1131%
Iowa Total Care $1,377 1289%
Geha $1,390 1301%
Medicaid / KanCare $1,398 - $1,404 1309%
Amish Hospital Aid $1,479 1385%
1199 National Benefit Fund $1,642 1537%
Aetna $1,642 1537%
Allied Benefit Systems $1,642 1537%
Asr Health Benefits $1,642 1537%
Christian Brother Services $1,642 1537%
Coventry $1,642 1537%
First Health $1,642 1537%
Luminare Health $1,642 1537%
Medical Mutual $1,642 1537%
Meritain $1,642 1537%
Trustmark Small Business Benefits $1,642 1537%
Webtpa $1,642 1537%
Auxiant $1,787 1673%
Cigna $1,787 1673%
Medica $1,787 1673%
Midlands $1,787 1673%
Midlands Choice $1,787 1673%
Multiplan $1,787 1673%
Ambetter / Centene $1,868 1749%
Crime Victim Assistance $1,986 1859%
Iowa Dept Of Public Health $1,986 1859%
Claimdoc $2,235 2093%
Nova $2,235 2093%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1111 3Rd Street Sw, Dyersville, IA 52040
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals