CMS Price Transparency Data

CT scan, pelvis

Facility: M Health Fairview St John's Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $193
Cash Discount Price: $491
vs. Medicare Baseline: 1.81x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at M Health Fairview St John's Hospital is $193. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $491. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.81x the Medicare baseline. Located in 1575 Beam Avenue, Maplewood, MN.

Cash / Self-Pay

$491

Average discount available for prompt cash payment at this facility.

Insurance Median

$193

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: $491 (460%)

Insurance Median: $193 (181%)

Cash: $491 (460% of Medicare)

Ins. Median: $193 (181% 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
Health Partners	$35 - $319	33%
Primewest	$35 - $130	33%
South Country Health Alliance	$35 - $130	33%
Ucare	$36 - $361	34%
Medica	$38 - $841	36%
Blue Cross Blue Shield	$40 - $488	37%
Itasca Medical Care	$40 - $130	37%
Sanford Health Plan	$48 - $739	45%
Security Health Plan	$48 - $941	45%
UnitedHealthcare	$48 - $521	45%
Wellcare	$48 - $130	45%
Hennepin Health	$54 - $147	51%
America'S Ppo	$622 - $903	582%
First Health	$979 - $1,029	917%
Multiplan	$1,015 - $1,066	950%
Private Healthcare Systems	$1,015 - $1,066	950%
Wisconsin Physician Services	$1,075 - $1,129	1006%

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 $491.
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 M Health Fairview St John's 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.