CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Loyola Gottlieb Memorial Hospital

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74177
Insurance Median: $449
Cash Discount Price: $1,101
vs. Medicare Baseline: 1.26x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Loyola Gottlieb Memorial Hospital is $449. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,101. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 1.26x the Medicare baseline. Located in 701 West North Ave, Melrose Park, IL.

Cash / Self-Pay

$1,101

Average discount available for prompt cash payment at this facility.

Insurance Median

$449

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: $1,101 (309%)

Insurance Median: $449 (126%)

Cash: $1,101 (309% of Medicare)

Ins. Median: $449 (126% 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.

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
Meridian	$316 - $432	89%
Molina	$316 - $391	89%
Blue Cross Blue Shield	$346 - $4,033	97%
Aetna	$372 - $4,230	104%
Vaccn United	$372	104%
Humana	$381 - $1,206	107%
Cigna	$383 - $1,170	107%
Ambetter / Centene	$391	110%
Wellcare	$391	110%
Oscar Ifp	$410	115%
Molina Marketplace Ifp	$465	130%
UnitedHealthcare	$1,065 - $1,161	299%

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 $1,101.
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 Loyola Gottlieb Memorial Hospital 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.