CMS Price Transparency Data

CT scan, chest (no contrast)

Facility: T J Samson Community Hospital

Billing Code: 71250 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 71250
Insurance Median: $128
Cash Discount Price: $578
vs. Medicare Baseline: 1.20x Medicare

The contracted insurance negotiated median rate for a CT scan, chest (no contrast) at T J Samson Community Hospital is $128. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $578. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.20x the Medicare baseline. Located in 1301 North Race Street, Glasgow, KY.

Cash / Self-Pay

$578

Average discount available for prompt cash payment at this facility.

Insurance Median

$128

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: $578 (541%)

Insurance Median: $128 (120%)

Cash: $578 (541% of Medicare)

Ins. Median: $128 (120% 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.

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
Blue Cross Blue Shield	$48 - $1,403	45%
Center Care Select - All Plans	$48 - $1,403	45%
Signature Health - All Plans	$48 - $107	45%
Wellcare Mcr Adv - All Other Plans	$48 - $106	45%
Molina Mcr Adv	$49 - $108	46%
Devoted Mcr Adv - All Plans	$50 - $112	47%
Humana	$51 - $209	48%
Caresource - All Plans	$62 - $159	58%
Molina Marketplace - All Other Plans	$62 - $159	58%
Wellcare Mcaid	$104 - $128	97%
Aetna	$128 - $209	120%
Molina Mcaid	$132 - $216	124%
UnitedHealthcare	$1,283	1201%
Phcs/Multiplan - All Plans	$1,552	1453%
First Health - All Plans	$1,568	1468%

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 $578.
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 T J Samson Community 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.