CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Mary Hitchcock Memorial Hospital

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 74177
  • Insurance Median: $652
  • Cash Discount Price: $1,261
  • vs. Medicare Baseline: 1.83x Medicare
The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Mary Hitchcock Memorial Hospital is $652. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,261. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 1.83x the Medicare baseline. Located in 1 Medical Center Drive, Lebanon, NH.
Cash / Self-Pay
$1,261

Average discount available for prompt cash payment at this facility.

Insurance Median
$652

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: $1,261 (354%)
Insurance Median: $652 (183%)
Cash: $1,261 (354% of Medicare)
Ins. Median: $652 (183% 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.

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 $41 - $784 12%
Beacon Health Strategies/Carelon $46 - $784 13%
Amerihealth Caritas Nh $47 - $728 13%
Granite State Health Plan $47 - $808 13%
Aetna $81 - $4,508 23%
Blue Cross Blue Shield $84 - $5,595 24%
Martin'S Point Generations Advantage $84 - $400 24%
Mvp $84 - $4,302 24%
UnitedHealthcare $84 - $4,931 24%
Martin'S Point Health Care $85 - $2,215 24%
Cigna $86 - $4,405 24%
Wellcare Health Plans $87 - $416 24%
Ambetter / Centene $88 - $860 25%
Harvard Pilgrim Health Care Of Ne $105 - $4,119 29%
Mass General Brigham Health Plan $243 - $3,994 68%
Tufts Health Plan $279 - $3,746 78%
Maine Community Health Options $1,160 - $4,719 325%
Coventry $1,584 - $5,586 444%
First Health/Hcvm $1,584 - $5,586 444%
Phcs $1,639 - $5,779 460%
Corvel $1,675 - $5,907 470%
Ccmsi $1,730 - $6,100 485%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1 Medical Center Drive, Lebanon, NH 03756
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals