CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Cheshire Medical Center

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74177
Insurance Median: $685
Cash Discount Price: $929
vs. Medicare Baseline: 1.92x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Cheshire Medical Center is $685. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $929. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 1.92x the Medicare baseline. Located in 580 Court Street, Keene, NH.

Cash / Self-Pay

$929

Average discount available for prompt cash payment at this facility.

Insurance Median

$685

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: $929 (261%)

Insurance Median: $685 (192%)

Cash: $929 (261% of Medicare)

Ins. Median: $685 (192% 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
Aetna	$81 - $3,994	23%
Ambetter / Centene	$90 - $332	25%
Blue Cross Blue Shield	$90 - $4,638	25%
Cigna	$90 - $2,890	25%
Martin'S Point Generations Advantage	$90 - $373	25%
Martin'S Point Health Care	$90 - $373	25%
Mvp	$90 - $2,890	25%
UnitedHealthcare	$90 - $4,432	25%
Wellcare Health Plans	$90 - $373	25%
Wellsense Health Plan	$90 - $805	25%
Amerihealth Caritas Nh	$110 - $715	31%
Granite State Health Plan	$149 - $975	42%
Harvard Pilgrim Health Care Of Ne	$191 - $2,655	54%
Mass General Brigham Health Plan	$234 - $5,839	66%
Tufts Health Plan	$254 - $3,727	71%
Maine Community Health Options	$403 - $2,628	113%
First Health/Hcvm	$761 - $4,963	214%
Phcs	$806 - $5,255	226%

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 $929.
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 Cheshire Medical Center 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.