CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: CHI Health Good Samaritan

Billing Code: 74177 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$970

about 2.7× the $356 Medicare rate · typically $441–$1,777

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,472

Above the fair price

about $502 over the fair price · 4.1× Medicare

Medicare pays $356 Fair price $970 This hospital $1,472 Cash price $3,606 Hospital's list price $5,911

How we calculate the fair BaseRate →

How this hospital compares to other NE hospitals

Highest price of the 9 NE hospitals we have prices for — worth calling around.

Cheapest $210 Priciest $1,472

Black dot = this hospital, among the 9 NE hospitals with a price for this procedure. Full list below.

A fair price for a CT scan, abdomen and pelvis (with contrast) is about $970 (about 2.7× the $356 Medicare rate). CHI Health Good Samaritan charges insurers about $1,472, or about $3,606 in cash — above the fair price. Located in Kearney, NE.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $970. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

3 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Humana AetnaCignaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$338 - $4,492	95%
Blue Cross Blue Shieldmajor	$338	95%
Humanamajor	$338	95%
Ambetter (Centene)	$291 - $1,254	82%
Amerigroup	$291 - $355	82%
Medica	$338 - $4,611	95%
Molina	$297	83%
+ 9 smaller / regional plans	$338 - $3,428

Excludes 2 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 3,606), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 74177.

Insurance Before you use insurance

Call your insurance company to confirm CHI Health Good Samaritan is in-network.
Ask your insurer whether prior approval is required for CPT code 74177.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at CHI Health Good Samaritan

Compare: CT scan, abdomen and pelvis (with contrast) at other NE hospitals

Insurance negotiated median for the same procedure, sorted lowest first.