CMS Price Transparency Data

CT scan, abdomen and pelvis (no contrast)

Facility: Mary Hitchcock Memorial Hospital

Billing Code: 74176 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74176
Insurance Median: $358
Cash Discount Price: $1,229
vs. Medicare Baseline: 1.47x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (no contrast) at Mary Hitchcock Memorial Hospital is $358. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,229. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 1.47x the Medicare baseline. Located in 1 Medical Center Drive, Lebanon, NH.

Cash / Self-Pay

$1,229

Average discount available for prompt cash payment at this facility.

Insurance Median

$358

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: $1,229 (504%)

Insurance Median: $358 (147%)

Cash: $1,229 (504% of Medicare)

Ins. Median: $358 (147% 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
Wellsense Health Plan	$39 - $769	16%
Aetna	$77 - $4,419	32%
Blue Cross Blue Shield	$80 - $5,485	33%
Martin'S Point Generations Advantage	$80 - $270	33%
Mvp	$80 - $4,218	33%
UnitedHealthcare	$80 - $4,835	33%
Cigna	$82 - $4,318	34%
Martin'S Point Health Care	$82 - $2,172	34%
Wellcare Health Plans	$83 - $281	34%
Ambetter / Centene	$84 - $582	34%
Beacon Health Strategies/Carelon	$97 - $769	40%
Amerihealth Caritas Nh	$99 - $713	41%
Granite State Health Plan	$99 - $793	41%
Harvard Pilgrim Health Care Of Ne	$100 - $4,038	41%
Mass General Brigham Health Plan	$231 - $3,915	95%
Tufts Health Plan	$267 - $3,672	110%
Maine Community Health Options	$1,106 - $4,627	454%
Coventry	$1,510 - $5,477	619%
First Health/Hcvm	$1,510 - $5,477	619%
Phcs	$1,562 - $5,666	641%
Corvel	$1,597 - $5,791	655%
Ccmsi	$1,649 - $5,980	676%

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 $1,229.
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 Mary Hitchcock Memorial Hospital 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.