CMS Price Transparency Data

CT scan, pelvis

Facility: Memorial Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $204
Cash Discount Price: $1,084
vs. Medicare Baseline: 1.91x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Memorial Hospital is $204. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,084. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.91x the Medicare baseline. Located in 715 South Taft Avenue, Fremont, OH.

Cash / Self-Pay

$1,084

Average discount available for prompt cash payment at this facility.

Insurance Median

$204

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: $1,084 (1015%)

Insurance Median: $204 (191%)

Cash: $1,084 (1015% of Medicare)

Ins. Median: $204 (191% 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
Meridian Health Plan Of Mi	$57 - $571	53%
Paramount Healthcare Inc	$96 - $934	90%
Aetna	$97 - $1,047	91%
Blue Cross Blue Shield	$97 - $557	91%
Humana	$97 - $571	91%
Molina Healthcare Of Ohio	$97 - $879	91%
Summacare	$97 - $917	91%
Health Alliance Plan	$99 - $1,084	93%
Buckeye Community Health Plan	$122 - $422	114%
Frontpath	$122 - $1,019	114%
Caresource	$124 - $557	116%
UnitedHealthcare	$134 - $754	125%
Cigna	$139 - $1,162	130%
Health Ohio Network	$169 - $1,150	158%
Amerihealth	$204 - $440	191%
Multiplan	$360 - $1,500	337%
Medical Mutual Of Ohio	$397 - $1,114	372%

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 $1,084.
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 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.