CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Good Samaritan Medical Center LLC

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74177
Insurance Median: $3,364
Cash Discount Price: Unavailable
vs. Medicare Baseline: 9.44x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Good Samaritan Medical Center LLC is $3,364. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 9.44x the Medicare baseline. Located in 200 Exempla Cir, Lafayette, CO.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,364

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%)

Insurance Median: $3,364 (944%)

Ins. Median: $3,364 (944% 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 944% of the Medicare baseline (a markup of 844%). 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
Aarp	$355	100%
UnitedHealthcare	$355 - $4,890	100%
Kaiser Snp	$359	101%
Select Health	$359	101%
Aetna	$760 - $7,563	213%
Geha	$828 - $4,890	232%
Preferred One	$828 - $3,364	232%
Blue Cross Blue Shield	$886 - $7,098	249%
Denv Hlth Med Plan	$933	262%
Cigna	$981 - $8,431	275%
Kaiser Perm Hmo	$1,560 - $3,552	438%
Kaiser Self Funded	$1,939 - $3,552	544%
Kaiser Perm Ppo/Pos	$1,968 - $3,660	552%
Allegiance	$2,108	591%
Humana	$3,541	993%
Cofinity	$6,076	1705%
First Health Network	$6,076	1705%
Private Hlthcare Sys	$6,324	1774%
Multiplan Inc	$7,167	2011%

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 $X.
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 Medical Center LLC 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.