CMS Price Transparency Data

CT scan, pelvis

Facility: Memorial Hospital of Carbon County

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $792
Cash Discount Price: $924
vs. Medicare Baseline: 7.42x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Memorial Hospital of Carbon County is $792. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $924. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.42x the Medicare baseline. Located in 2221 West Elm Street, Rawlins, WY.

Cash / Self-Pay

$924

Average discount available for prompt cash payment at this facility.

Insurance Median

$792

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: $924 (865%)

Insurance Median: $792 (742%)

Cash: $924 (865% of Medicare)

Ins. Median: $792 (742% 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 742% of the Medicare baseline (a markup of 642%). 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
Lhi	$334	313%
Three_River_Providers_Network	$502 - $1,346	470%
Wise_Provider_Networks	$502 - $1,346	470%
Zelis	$502 - $1,346	470%
Corechoice	$603 - $1,616	565%
First_Choice_Health	$603 - $1,616	565%
Blue Cross Blue Shield	$616 - $1,651	577%
Cigna	$623 - $1,669	583%
UnitedHealthcare	$643 - $1,723	602%
Interwests_Ppo_Network	$650 - $1,741	609%
Multiplan	$650 - $1,741	609%
Medicare (plans)	$933	874%
Vaccn	$933	874%
Medicaid / KanCare	$1,795	1681%

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 $924.
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 Memorial Hospital of Carbon County 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.