CMS Price Transparency Data

CT scan, chest (no contrast)

Facility: St Marys Good Samaritan Hospital

Billing Code: 71250 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 71250
Insurance Median: $509
Cash Discount Price: $1,225
vs. Medicare Baseline: 4.77x Medicare

The contracted insurance negotiated median rate for a CT scan, chest (no contrast) at St Marys Good Samaritan Hospital is $509. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,225. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.77x the Medicare baseline. Located in 5401 Lake Oconee Parkway, Greensboro, GA.

Cash / Self-Pay

$1,225

Average discount available for prompt cash payment at this facility.

Insurance Median

$509

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: $1,225 (1147%)

Insurance Median: $509 (477%)

Cash: $1,225 (1147% of Medicare)

Ins. Median: $509 (477% 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 477% of the Medicare baseline (a markup of 377%). 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
Peach State	$261	244%
Wellcare	$261 - $509	244%
Blue Cross Blue Shield	$364 - $1,362	341%
Aetna	$509 - $1,508	477%
Ambetter / Centene	$509	477%
Care Improvement Plus	$509	477%
Caresource	$509	477%
Cigna	$509 - $1,546	477%
Coventry	$509 - $1,414	477%
Eon Health Plan	$509	477%
Humana	$509 - $1,414	477%
Kaiser Permanente	$509	477%
Molina	$509	477%
Pruitthealth Premier	$509	477%
Todays Options Pffs	$509	477%
Todays Options Ppo	$509	477%
UnitedHealthcare	$509 - $2,632	477%
Vaccn United	$509	477%
First Health	$1,414	1324%
Phcs	$1,414	1324%
Meritain	$1,508	1412%
Multiplan	$1,602 - $1,640	1500%
Nova	$1,602 - $1,696	1500%
Three Rivers Provider Network	$1,696	1588%
Amerigroup	$1,885	1765%

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 $1,225.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 71250.

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 71250.
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.