CMS Price Transparency Data

CT scan, abdomen and pelvis (no contrast)

Facility: Sanford Westbrook Medical Center

Billing Code: 74176 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74176
Insurance Median: $3,886
Cash Discount Price: $3,886
vs. Medicare Baseline: 15.94x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (no contrast) at Sanford Westbrook Medical Center is $3,886. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,886. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 15.94x the Medicare baseline. Located in 920 Bell Avenue Po Box 188, Westbrook, MN.

Cash / Self-Pay

$3,886

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,886

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)

Cash / Self-Pay: $3,886 (1594%)

Insurance Median: $3,886 (1594%)

Cash: $3,886 (1594% of Medicare)

Ins. Median: $3,886 (1594% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 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 1594% of the Medicare baseline (a markup of 1494%). 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
Ucare	$254 - $4,267	104%
Blue Cross Blue Shield	$578 - $1,156	237%
Sanford Health Plan Align	$2,079	853%
Wellmark Sd	$2,229	914%
Aetna	$2,254 - $4,221	925%
Health Partners	$2,254 - $3,886	925%
Medicare (plans)	$2,254	925%
UnitedHealthcare	$2,254 - $4,056	925%
Primewest	$2,295 - $2,458	941%
Security Health Plan	$2,671	1096%
Sanford Health Plan	$3,834 - $4,511	1573%
Medica	$4,269 - $4,595	1751%
Cigna	$4,371	1793%
First Choice Health Network	$4,371	1793%
Healthez	$4,371	1793%
Multiplan	$4,371	1793%

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 $3,886.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 74176.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Sanford Westbrook Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 74176.
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.