CMS Price Transparency Data

CT scan, pelvis

Facility: Sanford Clear Lake Medical Center

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $1,993
Cash Discount Price: $1,944
vs. Medicare Baseline: 18.66x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Sanford Clear Lake Medical Center is $1,993. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,944. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 18.66x the Medicare baseline. Located in 701 Third Avenue South, Clear Lake, SD.

Cash / Self-Pay

$1,944

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,993

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: $1,944 (1820%)

Insurance Median: $1,993 (1866%)

Cash: $1,944 (1820% of Medicare)

Ins. Median: $1,993 (1866% 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 1866% of the Medicare baseline (a markup of 1766%). 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
Blue Cross Blue Shield	$705	660%
Sanford Health Plan Align	$1,247	1167%
Security Health Plan	$1,336	1251%
Ucare	$1,339 - $2,135	1254%
Wellmark Sd	$1,339	1254%
Aetna	$1,351 - $2,112	1265%
Health Partners	$1,351 - $1,822	1265%
Medicare (plans)	$1,351	1265%
UnitedHealthcare	$1,351 - $2,029	1265%
Primewest	$1,378	1290%
Sanford Health Plan	$1,684 - $2,260	1577%
Medica	$2,005 - $2,143	1877%
Wellmark	$2,090 - $2,114	1957%
Cigna	$2,187	2048%
First Choice Health Network	$2,187	2048%
Healthez	$2,187	2048%
Multiplan	$2,187	2048%

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 $1,944.
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 Sanford Clear Lake Medical 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.