CMS Price Transparency Data

CT scan, pelvis

Facility: Medicine Lodge Memorial Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72192
  • Insurance Median: $601
  • Cash Discount Price: $633
  • vs. Medicare Baseline: 5.63x Medicare
The contracted insurance negotiated median rate for a CT scan, pelvis at Medicine Lodge Memorial Hospital is $601. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $633. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.63x the Medicare baseline. Located in 710 N Walnut Street, Medicine Lodge, KS.
Cash / Self-Pay
$633

Average discount available for prompt cash payment at this facility.

Insurance Median
$601

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: $633 (593%)
Insurance Median: $601 (563%)
Cash: $633 (593% of Medicare)
Ins. Median: $601 (563% 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 563% of the Medicare baseline (a markup of 463%). 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
Tricare $507 475%
Humana $576 539%
Aetna $585 - $633 548%
Hpk-All Plans $601 563%
UnitedHealthcare $601 563%
Medicaid / KanCare $633 593%

Consumer Guidance & Cost Commentary

For a CT scan of the pelvis at Medicine Lodge Memorial Hospital in Medicine Lodge, Kansas, the cash price is $633.00, which matches the facility's gross charge and the median amount paid by Medicaid/KanCare. While the facility is a Critical Access Hospital owned by a Government Hospital District, the data does not provide specific county or state average rates for comparison. It is important to note that for patients with high-deductible plans, paying the cash price of $633.00 upfront can sometimes be more cost-effective than relying on insurance, as commercial negotiated rates for this service range from $507 to $633 depending on the specific payer. Patients should verify their specific plan's deductible status and ask the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can reduce the final bill.

The Medicare benchmark for this procedure is $106.81, which serves as a baseline to evaluate the facility's pricing markup. The median negotiated rate across payers is $601.00, which is slightly lower than the cash price, though some payers like Aetna have a range extending up to the gross charge. Because the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, patients should not fear unexpected bills for this service if the hospital is in-network. However, if a patient receives an itemized bill that appears higher than the negotiated amount, they should request a formal written audit to identify potential errors, such as unbundled codes or services not rendered, rather than accepting a summary bill immediately.

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 710 N Walnut Street, Medicine Lodge, KS 67104
  • CMS Rating: No CMS Rating
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Critical Access Hospitals