CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Ascension St John Jane Phillips

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 74177
  • Insurance Median: $375
  • Cash Discount Price: $1,188
  • vs. Medicare Baseline: 1.05x Medicare
The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Ascension St John Jane Phillips is $375. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,188. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 1.05x the Medicare baseline. Located in 3500 East Frank Phillips Boulevard, Bartlesville, OK.
Cash / Self-Pay
$1,188

Average discount available for prompt cash payment at this facility.

Insurance Median
$375

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: $1,188 (333%)
Insurance Median: $375 (105%)
Cash: $1,188 (333% of Medicare)
Ins. Median: $375 (105% 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.

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
Aetna $222 - $334 62%
Champva $364 102%
Community Care - St John Network Senior - Govt $364 102%
Communitycare Senior $364 102%
Life Pace $364 102%
Longevity Health Plan Of Oklahoma $364 102%
Medicare (plans) $364 102%
UnitedHealthcare $364 - $375 102%
Va Community Care Network $364 102%
Veterans Administration $364 102%
Humana $367 103%
Blue Cross Blue Shield $382 - $706 107%
Communitycare (Standard) $400 112%
Community Care (Select) 7/1/13 $437 123%
Ccl&H $473 133%
Smarthealth $509 143%
Community Care Smarthealth $546 - $873 153%
Communitycare (Select) $546 - $837 153%
Connect Health Benefit $728 204%
Evolutions $728 204%
Kempton Group Administrators $819 230%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 3500 East Frank Phillips Boulevard, Bartlesville, OK 74006
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals