CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: St Marys Good Samaritan Hospital

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74177
Insurance Median: $498
Cash Discount Price: $1,199
vs. Medicare Baseline: 1.40x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at St Marys Good Samaritan Hospital is $498. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,199. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 1.40x the Medicare baseline. Located in 5401 Lake Oconee Parkway, Greensboro, GA.

Cash / Self-Pay

$1,199

Average discount available for prompt cash payment at this facility.

Insurance Median

$498

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: $1,199 (336%)

Insurance Median: $498 (140%)

Cash: $1,199 (336% of Medicare)

Ins. Median: $498 (140% 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.

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
Peach State	$298	84%
Wellcare	$298 - $498	84%
Blue Cross Blue Shield	$356 - $1,332	100%
Aetna	$498 - $1,475	140%
Ambetter / Centene	$498	140%
Care Improvement Plus	$498	140%
Caresource	$498	140%
Cigna	$498 - $1,512	140%
Coventry	$498 - $1,383	140%
Eon Health Plan	$498	140%
Humana	$498 - $1,383	140%
Kaiser Permanente	$498	140%
Molina	$498	140%
Pruitthealth Premier	$498	140%
Todays Options Pffs	$498	140%
Todays Options Ppo	$498	140%
UnitedHealthcare	$498 - $2,632	140%
Vaccn United	$498	140%
First Health	$1,383	388%
Phcs	$1,383	388%
Meritain	$1,475	414%
Multiplan	$1,567 - $1,604	440%
Nova	$1,567 - $1,660	440%
Three Rivers Provider Network	$1,660	466%
Amerigroup	$1,844	517%

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 $1,199.
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 St Marys 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.