CMS Price Transparency Data

CT scan, pelvis

Facility: Upland Hills Health

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $804
Cash Discount Price: $917
vs. Medicare Baseline: 7.53x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Upland Hills Health is $804. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $917. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.53x the Medicare baseline. Located in 800 Compassion Way, Dodgeville, WI.

Cash / Self-Pay

$917

Average discount available for prompt cash payment at this facility.

Insurance Median

$804

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: $917 (859%)

Insurance Median: $804 (753%)

Cash: $917 (859% of Medicare)

Ins. Median: $804 (753% 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 753% of the Medicare baseline (a markup of 653%). 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
UnitedHealthcare	$100 - $488	94%
Ghc Of Eau Claire	$143	134%
Ghc Of Sc Wi	$143 - $1,951	134%
Mhs	$143 - $804	134%
Humana	$168 - $2,583	157%
Dean Health Plan	$241 - $1,996	226%
Alliance	$332 - $1,622	311%
Blue Cross Blue Shield	$804 - $2,353	753%
Icare	$804	753%
Medical Associates	$804 - $1,025	753%
Security Health Plan	$804	753%
Quartz	$856	801%
Wps	$1,751 - $1,805	1639%
Cigna	$2,141 - $2,393	2004%
Multiplan	$2,525	2364%

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 $917.
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 Upland Hills Health 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.