CMS Price Transparency Data

CT scan, pelvis

Facility: Mc Donough District Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $273
Cash Discount Price: $600
vs. Medicare Baseline: 2.56x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Mc Donough District Hospital is $273. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $600. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.56x the Medicare baseline. Located in 525 East Grant Street, Macomb, IL.

Cash / Self-Pay

$600

Average discount available for prompt cash payment at this facility.

Insurance Median

$273

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: $600 (562%)

Insurance Median: $273 (256%)

Cash: $600 (562% of Medicare)

Ins. Median: $273 (256% 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 256% of the Medicare baseline (a markup of 156%). 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
Health Alliance	$29 - $1,495	27%
Hfn	$46 - $1,512	43%
UnitedHealthcare	$46 - $1,512	43%
Aetna	$49 - $1,680	46%
Humana	$49 - $1,512	46%
Medicaid / KanCare	$49 - $1,680	46%
Medicare (plans)	$49 - $119	46%
Meridian	$49 - $119	46%
Molina	$49 - $1,680	46%
Mutual Medical	$49 - $1,680	46%
Veteran Affairs	$49 - $119	46%
Tricare	$111	104%
Blue Cross Blue Shield	$134 - $1,680	125%
Springfield Health	$263 - $1,378	246%
Consociate	$273 - $1,428	256%
Trilogy	$273 - $1,428	256%
Blue Choice	$289 - $1,512	271%
Current Health	$289 - $1,512	271%
Healthlink	$289 - $1,579	271%
Preferred Plan	$305 - $1,596	286%

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 $600.
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 Mc Donough District 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.