CMS Price Transparency Data

CT scan, pelvis

Facility: Sparrow Ionia Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $458
Cash Discount Price: $296
vs. Medicare Baseline: 4.29x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Sparrow Ionia Hospital is $458. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $296. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.29x the Medicare baseline. Located in 3565 S State Road, Ionia, MI.

Cash / Self-Pay

$296

Average discount available for prompt cash payment at this facility.

Insurance Median

$458

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: $296 (277%)

Insurance Median: $458 (429%)

Cash: $296 (277% of Medicare)

Ins. Median: $458 (429% 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 429% of the Medicare baseline (a markup of 329%). 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
Medicaid / KanCare	$33 - $117	31%
Medicare (plans)	$49 - $485	46%
Blue Cross Blue Shield	$81 - $1,147	76%
Priority Health Medihmo	$107	100%
Aetna	$112 - $1,372	105%
Covenant Advantage	$458	429%
Medigold	$458	429%
Senior Community Care	$458	429%
Humana	$480 - $1,482	449%
Priority	$1,123	1051%
UnitedHealthcare	$1,404	1314%
Cigna	$1,449	1357%
Great West Healthcare	$1,449	1357%
Asr	$1,464	1371%
Blue Care Network	$1,464	1371%
Health Alliance Plan	$1,464	1371%
Cofinity	$1,482	1388%
Mclaren Commercial	$1,631	1527%

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 $296.
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 Sparrow Ionia 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.