CMS Price Transparency Data

CT scan, abdomen and pelvis (no contrast)

Facility: Mary Hitchcock Memorial Hospital

Billing Code: 74176 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$250

about 1.0× the $244 Medicare rate · typically $209–$390

modeled estimate · not a bill or quote

What this hospital charges insurers

$275

About the fair price

about $25 over the fair price · 1.1× Medicare

Medicare pays $244 Fair price $250 This hospital $275 Cash price $1,229 Hospital's list price $4,016

How we calculate the fair BaseRate →

How this hospital compares to other NH hospitals

A typical price — 5 charge more and 3 charge less, among the 9 NH hospitals compared.

Cheapest $110 Priciest $652

Black dot = this hospital, among the 9 NH hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a CT scan, abdomen and pelvis (no contrast) is about $250 (about 1.0× the $244 Medicare rate). Mary Hitchcock Memorial Hospital charges insurers about $275, or about $1,229 in cash — about the fair price. Located in Lebanon, NH.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna HumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$80 - $4,835	33%
Blue Cross Blue Shieldmajor	$80 - $5,485	33%
Aetnamajor	$77 - $5,477	32%
Cignamajor	$82 - $4,318	34%
Ambetter (Centene)	$84 - $582	34%
AmeriHealth	$99 - $713	41%
Harvard Pilgrim	$100 - $4,038	41%
MVP Health Care	$80 - $4,218	33%
Tufts Health Plan	$267 - $3,672	110%
WellCare	$83 - $281	34%
WellSense	$39 - $769	16%
+ 7 smaller / regional plans	$80 - $5,980

Excludes 3 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 1,229), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 74176.

Insurance Before you use insurance

Call your insurance company to confirm Mary Hitchcock Memorial Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 74176.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Mary Hitchcock Memorial Hospital

Compare: CT scan, abdomen and pelvis (no contrast) at other NH hospitals

Insurance negotiated median for the same procedure, sorted lowest first.