CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Sanford Westbrook Medical Center

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 74177
  • Insurance Median: $4,656
  • Cash Discount Price: $4,656
  • vs. Medicare Baseline: 13.06x Medicare
The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Sanford Westbrook Medical Center is $4,656. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,656. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 13.06x the Medicare baseline. Located in 920 Bell Avenue Po Box 188, Westbrook, MN.
Cash / Self-Pay
$4,656

Average discount available for prompt cash payment at this facility.

Insurance Median
$4,656

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: $4,656 (1306%)
Insurance Median: $4,656 (1306%)
Cash: $4,656 (1306% of Medicare)
Ins. Median: $4,656 (1306% 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 1306% of the Medicare baseline (a markup of 1206%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 $375 - $5,113 105%
Blue Cross Blue Shield $608 - $1,216 171%
Sanford Health Plan Align $2,491 699%
Wellmark Sd $2,671 749%
Aetna $2,700 - $5,058 758%
Health Partners $2,700 - $4,656 758%
Medicare (plans) $2,700 758%
UnitedHealthcare $2,700 - $4,860 758%
Primewest $2,750 - $2,945 772%
Security Health Plan $3,201 898%
Sanford Health Plan $4,594 - $5,405 1289%
Medica $5,116 - $5,506 1435%
Cigna $5,238 1470%
First Choice Health Network $5,238 1470%
Healthez $5,238 1470%
Multiplan $5,238 1470%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 920 Bell Avenue Po Box 188, Westbrook, MN 56183
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals