CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Methodist Southlake Medical Center

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 74177
  • Insurance Median: $579
  • Cash Discount Price: $4,335
  • vs. Medicare Baseline: 1.62x Medicare
The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Methodist Southlake Medical Center is $579. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,335. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 1.62x the Medicare baseline. Located in 421 E State Highway 114, Southlake, TX.
Cash / Self-Pay
$4,335

Average discount available for prompt cash payment at this facility.

Insurance Median
$579

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: $4,335 (1216%)
Insurance Median: $579 (162%)
Cash: $4,335 (1216% of Medicare)
Ins. Median: $579 (162% 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
UnitedHealthcare $296 - $908 83%
Champva [1000] $341 96%
Tricare $341 96%
Triwest Wps [8010] $341 96%
Veterans Administration [9001] $341 96%
Aetna $351 - $4,855 98%
Blue Cross Blue Shield $351 - $2,612 98%
Medicare (plans) $351 - $376 98%
Ust Health Proof [1005] $351 98%
Wellcare [7016] $351 98%
American Health Advantage Of Texas [7099] $369 104%
Cigna $369 - $649 104%
Globalhealth [1003] $369 104%
Procare Advantage [7018] $369 104%
Humana $372 104%
Southwestern Health Resources Swhr [7015] $372 104%
Provider Partners Health Plan [7025] $379 106%
Alternative Service Concepts [8005] $439 123%
Oscar Insurance Company [2057] $456 128%
Bright Healthcare [2222] $491 138%
Friday Health Plan [2061] $500 140%
Molina [3017] $509 143%
Wellpoint Marketplace Exchange [3071] $544 153%
Kempton Group Administrators, Tower Extrusions [3061] $562 158%
90 Degree Benefit [3057] $579 162%
Allied National [2031] $579 162%
Entrust/90 Degree [2058] $579 162%
Ambetter / Centene $600 168%
Imperial Insurance Companies [3073] $632 177%
Web Tpa [3049] $649 - $1,445 182%
Department Of Labor [8004] $702 197%
Evry Health [1013] $702 197%
Generic Workers Comp Tx Non Par [9010] $702 197%
Generic Workers Comp Tx Par [8002] $702 197%
Generic Workers Comp Tx Par [9011] $702 197%
Sana Benefits [3069] $702 197%
Tristar Risk Management [8006] $702 197%
Velocity [3070] $702 197%
Health Plans Inc [5017] $878 246%
Medical Cost Containment Professionals [3059] $878 246%
Bind Benefits Inc [1004] $908 255%
Definity Health [3006] $908 255%
Freedom Life Insurance Company [2029] $908 255%
Geha Federal [3066] $908 255%
Tml Intergovernmental Employee Benefits [3050] $908 255%
Dart Member Care [3039] $948 266%
Healthscope Benefits [2052] $948 266%
Healthscope Benefits [3063] $948 266%
Medicaid / KanCare $1,099 - $1,334 308%
Scott & White Health Plan Trs [3062] $4,855 1362%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 421 E State Highway 114, Southlake, TX 76092
  • CMS Rating: No CMS Rating
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals