CMS Price Transparency Data

CT scan, pelvis

Facility: Primary Children's Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72192
  • Insurance Median: $853
  • Cash Discount Price: $901
  • vs. Medicare Baseline: 7.99x Medicare
The contracted insurance negotiated median rate for a CT scan, pelvis at Primary Children's Hospital is $853. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $901. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.99x the Medicare baseline. Located in 100 North Mario Capecchi Drive, Salt Lake City, UT.
Cash / Self-Pay
$901

Average discount available for prompt cash payment at this facility.

Insurance Median
$853

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: $901 (844%)
Insurance Median: $853 (799%)
Cash: $901 (844% of Medicare)
Ins. Median: $853 (799% 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 799% of the Medicare baseline (a markup of 699%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
American Health $51 - $685 48%
Health Plan Of Nevada $51 - $81 48%
Healthy U $51 - $81 48%
Molina $51 - $1,009 48%
Selecthealth $51 - $1,009 48%
Southwest Behavioral Health $51 - $100 48%
UnitedHealthcare $51 - $1,009 48%
Tricare $102 95%
Triwest $102 95%
Donor Connect $433 - $478 405%
Aetna $853 - $1,021 799%
Awh Connected $853 - $1,021 799%
Byu Athletics $853 - $1,009 799%
Campbell Scientific $853 - $1,009 799%
Cigna $853 - $1,009 799%
Deseret Mutual $853 - $1,009 799%
Emi $853 - $1,009 799%
Emi Health $853 - $1,009 799%
First Choice $853 - $1,009 799%
First Choice Of The Midwest $853 - $1,009 799%
Franklin County $853 - $1,009 799%
Global Excel $853 - $1,009 799%
Health Utah $853 - $1,009 799%
Humana $853 - $1,009 799%
Hygeia Corporation $853 - $1,009 799%
Ifit $853 - $1,009 799%
Juniper Systems $853 - $1,009 799%
Lw Miller $853 - $1,009 799%
Managed Care Admin $853 - $1,009 799%
Medcare International $853 - $1,009 799%
Motivhealth $853 - $1,009 799%
Pehp $853 - $1,009 799%
Prodegi Corp Benefit $853 - $1,009 799%
Tanner Llc $853 - $1,009 799%
Uofu $853 - $1,009 799%
Utah Tech $853 - $1,009 799%
Wise Network $853 - $1,009 799%
First Health $865 - $1,021 810%
Blue Cross Blue Shield $877 - $1,033 821%
Springtide $877 - $1,033 821%
Utah Behavioral Health Network $973 911%
Altius Mhnet Behavioral Health $1,057 990%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 100 North Mario Capecchi Drive, Salt Lake City, UT 84113
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Childrens