CMS Price Transparency Data

CT scan, abdomen and pelvis (no contrast)

Facility: Memorial Hospital and Health Care Center

Billing Code: 74176 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74176
Insurance Median: $171
Cash Discount Price: $175
vs. Medicare Baseline: 0.70x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (no contrast) at Memorial Hospital and Health Care Center is $171. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $175. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 0.70x the Medicare baseline. Located in 800 W 9Th St, Jasper, IN.

Cash / Self-Pay

$175

Average discount available for prompt cash payment at this facility.

Insurance Median

$171

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: $175 (72%)

Insurance Median: $171 (70%)

Cash: $175 (72% of Medicare)

Ins. Median: $171 (70% 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 Blue Shield	$64 - $483	26%
Aetna	$76 - $390	31%
Caresource In Marketplace	$76 - $317	31%
Humana	$76 - $253	31%
Tricare	$76 - $215	31%
Mdwise	$77 - $173	32%
Mhs Hoosier Care Connect	$77 - $173	32%
Chamber Care	$78	32%
Encore	$80 - $326	33%
Encore Elite +	$80 - $608	33%
UnitedHealthcare	$85 - $760	35%
Immergrun	$92 - $204	38%
Ambetter / Centene	$99 - $329	41%
Onecare	$99 - $221	41%
Siho	$99 - $221	41%
Patoka Valley	$107 - $271	44%
Noncontracted	$122 - $405	50%
Cigna	$173 - $390	71%
Sagamore	$173 - $390	71%

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 $175.
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 Memorial Hospital and Health Care 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.