CMS Price Transparency Data

CT scan, pelvis

Facility: Klickitat Valley Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $780
Cash Discount Price: $753
vs. Medicare Baseline: 7.30x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Klickitat Valley Hospital is $780. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $753. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.30x the Medicare baseline. Located in 310 South Roosevelt, Goldendale, WA.

Cash / Self-Pay

$753

Average discount available for prompt cash payment at this facility.

Insurance Median

$780

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: $753 (705%)

Insurance Median: $780 (730%)

Cash: $753 (705% of Medicare)

Ins. Median: $780 (730% 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 730% of the Medicare baseline (a markup of 630%). 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
Molina	$146 - $2,528	137%
Community Health Plan Of Wa	$148 - $1,264	139%
Pacificsource Health Plans	$148 - $2,107	139%
Coordinated Care	$149 - $1,272	140%
UnitedHealthcare	$153 - $2,040	143%
Wellpoint	$158 - $1,346	148%
Cigna	$230 - $1,966	215%
Health Net Health Plan Of Oregon	$313 - $2,669	293%
Moda Health Plan	$313 - $2,669	293%
Providence Health Plan	$313 - $2,669	293%

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 $753.
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 Klickitat Valley 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.