CMS Price Transparency Data

CT scan, pelvis

Facility: Jacobson Memorial Hospital Care Center

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $1,029
Cash Discount Price: $857
vs. Medicare Baseline: 9.63x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Jacobson Memorial Hospital Care Center is $1,029. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $857. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 9.63x the Medicare baseline. Located in 601 East St N, Elgin, ND.

Cash / Self-Pay

$857

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,029

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: $857 (802%)

Insurance Median: $1,029 (963%)

Cash: $857 (802% of Medicare)

Ins. Median: $1,029 (963% 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 963% of the Medicare baseline (a markup of 863%). 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
Aetna	$686 - $1,143	642%
Medicaid / KanCare	$818	766%
Tricare	$857	802%
UnitedHealthcare	$871 - $1,143	815%
Medica	$914	856%
Tlc Advantage	$914	856%
Cigna	$1,029	963%
Healthpartners	$1,029	963%
Medicare (plans)	$1,029 - $1,372	963%
Multiplan Commercial	$1,029	963%
Blue Cross Blue Shield	$1,143 - $1,600	1070%
Humana	$1,143	1070%
Nextblue	$1,143	1070%
Sanford Health Plan	$1,143	1070%

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 $857.
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 Jacobson Memorial Hospital Care Center 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.