CMS Price Transparency Data

CT scan, abdomen and pelvis (no contrast)

Facility: Wellspan Good Samaritan Hospital

Billing Code: 74176 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74176
Insurance Median: $406
Cash Discount Price: $243
vs. Medicare Baseline: 1.67x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (no contrast) at Wellspan Good Samaritan Hospital is $406. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $243. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 1.67x the Medicare baseline. Located in 252 South 4Th Street, Lebanon, PA.

Cash / Self-Pay

$243

Average discount available for prompt cash payment at this facility.

Insurance Median

$406

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: $243 (100%)

Insurance Median: $406 (167%)

Cash: $243 (100% of Medicare)

Ins. Median: $406 (167% 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
Blue_Cross	$126 - $828	52%
Wellspan_Capital_Blue_Cross	$196	80%
Medicaid / KanCare	$210 - $418	86%
Medicare (plans)	$239 - $258	98%
Aetna	$246 - $957	101%
Highmark	$370 - $870	152%
First_Health_Network	$1,052	432%
Cigna	$1,208	496%
United_Healthcare	$1,342	551%
Geisinger	$1,393	571%
Upmc	$1,393	571%
Phc	$1,858	762%

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 $243.
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 Wellspan Good Samaritan Hospital 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.