CMS Price Transparency Data

CT scan, pelvis

Facility: Holy Cross Hospital-Jordan Valley

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $1,385
Cash Discount Price: $1,128
vs. Medicare Baseline: 12.97x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Holy Cross Hospital-Jordan Valley is $1,385. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,128. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 12.97x the Medicare baseline. Located in 3580 West 9000 South, West Jordan, UT.

Cash / Self-Pay

$1,128

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,385

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: $1,128 (1056%)

Insurance Median: $1,385 (1297%)

Cash: $1,128 (1056% of Medicare)

Ins. Median: $1,385 (1297% 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 1297% of the Medicare baseline (a markup of 1197%). 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	$65 - $2,383	61%
Colorado Access	$65	61%
Denver Health	$65	61%
Health Choice	$65	61%
Molina	$65 - $1,211	61%
Rocky Mountain Health Plan	$65	61%
Uuhp	$65 - $581	61%
Humana	$75	70%
Medicare (plans)	$75	70%
Employer Direct Healthcare	$94	88%
Motivhealth	$99	93%
Blue Cross Blue Shield	$105 - $1,692	98%
Cigna	$243 - $2,256	228%
UnitedHealthcare	$307 - $2,821	287%
Centura Employee Plan	$337	316%
Pehp	$1,204 - $2,821	1127%
Wise	$1,467 - $1,495	1373%
Deseret Mutual Benefit Administrators	$1,732	1622%
Select Health	$1,867	1748%
Multiplan	$1,946 - $2,567	1822%
Emi Health	$2,821	2641%

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 $1,128.
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 Holy Cross Hospital-Jordan Valley 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.