CMS Price Transparency Data

CT scan, abdomen and pelvis (no contrast)

Facility: Legacy Good Samaritan Medical Center

Billing Code: 74176 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74176
Insurance Median: $410
Cash Discount Price: $912
vs. Medicare Baseline: 1.68x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (no contrast) at Legacy Good Samaritan Medical Center is $410. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $912. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 1.68x the Medicare baseline. Located in 1015 Nw 22Nd Avenue, W121, Portland, OR.

Cash / Self-Pay

$912

Average discount available for prompt cash payment at this facility.

Insurance Median

$410

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: $912 (374%)

Insurance Median: $410 (168%)

Cash: $912 (374% of Medicare)

Ins. Median: $410 (168% 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.

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
Aetna	$183 - $278	75%
Pacificsource	$228 - $522	94%
Kaiser	$265 - $530	109%
Atrio	$273	112%
Healthnet	$281 - $625	115%
Careoregon	$286	117%
Ageright	$292	120%
Moda	$297 - $1,026	122%
Cigna	$652	267%
Blue Cross Blue Shield	$657 - $963	270%

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 $912.
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 Legacy Good Samaritan 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.