CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Memorial Hospital and Manor

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74177
Insurance Median: $3,926
Cash Discount Price: $4,158
vs. Medicare Baseline: 11.01x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Memorial Hospital and Manor is $3,926. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,158. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 11.01x the Medicare baseline. Located in 1500 E Shotwell Street, Bainbridge, GA.

Cash / Self-Pay

$4,158

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,926

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: $4,158 (1167%)

Insurance Median: $3,926 (1101%)

Cash: $4,158 (1167% of Medicare)

Ins. Median: $3,926 (1101% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 1101% of the Medicare baseline (a markup of 1001%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Tricare	$299	84%
Aetna	$322 - $5,346	90%
Humana	$322 - $4,752	90%
Medicare (plans)	$322	90%
Wellcare_Plan	$322	90%
Ambetter / Centene	$418	117%
Tnga_Plan	$450	126%
Alliant_Plan	$515	144%
Amerigroup_Plan	$3,742	1050%
Medicaid / KanCare	$3,742	1050%
Peach_State_Health_Plan_Plan	$3,742	1050%
Caresource_Plan	$3,926	1101%
Blue Cross Blue Shield	$4,587	1287%
Uhc_Plan	$4,693	1317%
Novanet_Plan	$4,752	1333%
Cigna	$4,930	1383%
Private_Healthcare_Systems_Plan	$5,049	1417%
Multiplan_Plan	$5,346	1500%
Corvel_Plan	$5,643	1583%

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 $4,158.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 74177.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Memorial Hospital and Manor is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 74177.
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.