CMS Price Transparency Data

CT scan, pelvis

Facility: Gothenburg Health

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $2,087
Cash Discount Price: $2,408
vs. Medicare Baseline: 19.54x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Gothenburg Health is $2,087. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,408. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 19.54x the Medicare baseline. Located in Po Box 469 910 20Th St, Gothenburg, NE.

Cash / Self-Pay

$2,408

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,087

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: $2,408 (2254%)

Insurance Median: $2,087 (1954%)

Cash: $2,408 (2254% of Medicare)

Ins. Median: $2,087 (1954% 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 1954% of the Medicare baseline (a markup of 1854%). 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
UnitedHealthcare	$1,642	1537%
Blue Cross Blue Shield	$1,659 - $2,541	1553%
Aetna	$1,685 - $2,568	1578%
Nebraska Total Care	$2,488	2329%

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 $2,408.
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 Gothenburg Health 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.