CMS Price Transparency Data

CT scan, pelvis

Facility: Clearwater Valley Hospital & Clinics

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $570
Cash Discount Price: $480
vs. Medicare Baseline: 5.34x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Clearwater Valley Hospital & Clinics is $570. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $480. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.34x the Medicare baseline. Located in 301 Cedar Street, Orofino, ID.

Cash / Self-Pay

$480

Average discount available for prompt cash payment at this facility.

Insurance Median

$570

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: $480 (449%)

Insurance Median: $570 (534%)

Cash: $480 (449% of Medicare)

Ins. Median: $570 (534% 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 534% of the Medicare baseline (a markup of 434%). 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
Cigna	$43 - $1,026	40%
Humana	$48 - $1,106	45%
Nimiipuu Mcr Adv-All Plans	$48 - $622	45%
Regence Blue Shield Mcr	$48 - $616	45%
Veterans Amin-All Plans	$48 - $616	45%
Pacific Source - All Plans	$49 - $616	46%
Blue Cross Blue Shield	$55 - $832	51%
Aetna	$76 - $1,060	71%
UnitedHealthcare	$90	84%
Idaho Phys Network-All Plans	$134 - $1,083	125%
Multiplan / Phcs-All Plans	$135 - $1,106	126%
Corizon Correctnal Med-All Plans	$136 - $832	127%
Geha-All Plans	$137 - $1,117	128%
First Choice-All Plans	$138 - $1,117	129%
Regence Blue Shield-All Other Plans	$1,140	1067%

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 $480.
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 Clearwater Valley Hospital & Clinics 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.