CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Good Samaritan Hospital

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74177
Insurance Median: $4,973
Cash Discount Price: $44,564
vs. Medicare Baseline: 13.95x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Good Samaritan Hospital is $4,973. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $44,564. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 13.95x the Medicare baseline. Located in 2425 Samaritan Drive, San Jose, CA.

Cash / Self-Pay

$44,564

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,973

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$356.43

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $356.43 (100%)

Cash / Self-Pay: $44,564 (12503%)

Insurance Median: $4,973 (1395%)

Cash: $44,564 (12503% of Medicare)

Ins. Median: $4,973 (1395% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $356.43 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 1395% of the Medicare baseline (a markup of 1295%). 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
Physicians Medical Group	$203	57%
Santa Clara Family Health Plan	$210	59%
Blue Cross Blue Shield	$223 - $1,655	63%
United	$828 - $11,364	232%
Aetna	$2,044 - $5,074	573%
Blue Shield	$2,878	807%
Medcare Partners	$6,685	1876%
Nx Health Network	$26,739	7502%
Sutter Select	$26,739	7502%
Multiplan	$28,967 - $35,651	8127%
Humana	$31,195	8752%
First Health	$33,869 - $44,564	9502%
Cigna	$35,651	10002%
Healthsmart	$35,651 - $37,880	10002%
Intercontinental Corporation	$35,651	10002%
Pha Pacific Health Alliance	$35,651	10002%
Ppo Next	$35,651	10002%

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 $44,564.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 74177.

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 74177.
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.