CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Jones Memorial Hospital

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74177
Insurance Median: $267
Cash Discount Price: $680
vs. Medicare Baseline: 0.75x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Jones Memorial Hospital is $267. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $680. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 0.75x the Medicare baseline. Located in 191 North Main Street, Wellsville, NY.

Cash / Self-Pay

$680

Average discount available for prompt cash payment at this facility.

Insurance Median

$267

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: $680 (191%)

Insurance Median: $267 (75%)

Cash: $680 (191% of Medicare)

Ins. Median: $267 (75% 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
Blue Cross Blue Shield	$65 - $910	18%
Fidelis 5155	$65 - $109	18%
Medicaid / KanCare	$65 - $245	18%
UnitedHealthcare	$65 - $466	18%
Univera Healthcare 1706	$65 - $109	18%
Molina Healthcare 1723	$120 - $245	34%
Mvp 2900	$288 - $1,101	81%
UPMC Health Plan 5138	$350	98%
Humana	$466	131%
Medicare (plans)	$466 - $698	131%
Total Senior Care 1319	$466	131%
Aetna	$494 - $1,166	139%
Independent Health 5156	$698	196%
Empire Plan 5179	$826	232%
Cigna	$1,140	320%

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 $680.
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 Jones Memorial Hospital 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.