CMS Price Transparency Data

CT scan, pelvis

Facility: Gundersen Moundview Hospital and Clinics

Billing Code: 72192 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$286

about 2.7× the $107 Medicare rate · typically $92–$1,641

modeled estimate · not a bill or quote

Medicare pays $107 Fair price $286 Cash price $988 Hospital's list price $1,925

How we calculate the fair BaseRate →

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Humana CignaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$1,221	1143%
Blue Cross Blue Shieldmajor	$329 - $2,313	308%
Aetnamajor	$1,829	1712%
Humanamajor	$1,636	1532%
Amerigroup	$46	43%
Dean Health Plan	$535	501%
HealthPartners	$886 - $1,700	830%
Quartz	$1,049	982%
Security Health Plan	$886	830%
UCare	$886 - $1,540	830%
+ 5 smaller / regional plans	$329 - $1,829

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 988), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 72192.

Insurance Before you use insurance

Call your insurance company to confirm Gundersen Moundview Hospital and Clinics is in-network.
Ask your insurer whether prior approval is required for CPT code 72192.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Gundersen Moundview Hospital and Clinics

Compare: CT scan, pelvis at other WI hospitals

Insurance negotiated median for the same procedure, sorted lowest first.