CMS Price Transparency Data

CT scan, pelvis

Facility: Munson Healthcare Otsego Memorial Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $109
Cash Discount Price: $1,320
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Munson Healthcare Otsego Memorial Hospital is $109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,320. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.02x the Medicare baseline. Located in 825 N Center Ave, Gaylord, MI.

Cash / Self-Pay

$1,320

Average discount available for prompt cash payment at this facility.

Insurance Median

$109

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: $1,320 (1236%)

Insurance Median: $109 (102%)

Cash: $1,320 (1236% of Medicare)

Ins. Median: $109 (102% 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.

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
Blue Cross Blue Shield	$33 - $970	31%
Mclaren Health Plan	$33 - $1,302	31%
Meridian	$33 - $54	31%
Molina	$33 - $135	31%
Priority Health	$33 - $292	31%
UnitedHealthcare	$33 - $1,244	31%
Aetna	$49 - $1,258	46%
Blue Care Network	$49 - $125	46%
Hap (Health Alliance Plan)	$49 - $1,242	46%
Humana	$49 - $125	46%
Medicare (plans)	$49 - $125	46%
Michigan Amish Medical Board	$49 - $125	46%
Northern Michigan Mennonite Group	$49 - $125	46%
Asr Physicians Care Network	$73 - $1,242	68%
Cigna	$77 - $292	72%
Nomi Health	$78 - $1,242	73%
Employee Benefit Logistics	$83 - $212	78%
Munson Hospice	$852 - $1,087	798%
Hospice Of Michigan	$932	873%
Enterprise Group Planning/Employee Benefit Plan	$1,242	1163%
Cofinity	$1,320	1236%
Provider Network Of America/Hawaii Mainland Administrative Group Health	$1,320	1236%
Three Rivers Provider Network	$1,320	1236%

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 $1,320.
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 Munson Healthcare Otsego Memorial 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.