CMS Price Transparency Data

CT scan, abdomen and pelvis (no contrast)

Facility: Good Samaritan Hospital

Billing Code: 74176 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74176
Insurance Median: $4,772
Cash Discount Price: $31,817
vs. Medicare Baseline: 19.58x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (no contrast) at Good Samaritan Hospital is $4,772. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $31,817. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 19.58x the Medicare baseline. Located in 2425 Samaritan Drive, San Jose, CA.

Cash / Self-Pay

$31,817

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,772

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)

Cash / Self-Pay: $31,817 (13052%)

Insurance Median: $4,772 (1958%)

Cash: $31,817 (13052% of Medicare)

Ins. Median: $4,772 (1958% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 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 1958% of the Medicare baseline (a markup of 1858%). 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
Santa Clara Family Health Plan	$97	40%
Physicians Medical Group	$101	41%
Blue Cross Blue Shield	$111 - $1,001	46%
United	$518 - $8,113	212%
Blue Shield	$1,508	619%
Aetna	$2,044 - $5,074	838%
Medcare Partners	$4,772	1958%
Nx Health Network	$19,090	7831%
Sutter Select	$19,090	7831%
Multiplan	$20,681 - $25,453	8484%
Humana	$22,272	9136%
First Health	$24,181 - $31,817	9920%
Cigna	$25,453	10441%
Healthsmart	$25,453 - $27,044	10441%
Intercontinental Corporation	$25,453	10441%
Pha Pacific Health Alliance	$25,453	10441%
Ppo Next	$25,453	10441%

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 $31,817.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 74176.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Good Samaritan Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 74176.
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.