CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Ira Davenport Memorial Hospital

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74177
Insurance Median: $3,579
Cash Discount Price: $3,937
vs. Medicare Baseline: 10.04x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Ira Davenport Memorial Hospital is $3,579. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,937. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 10.04x the Medicare baseline. Located in 7571 State Route 54, Bath, NY.

Cash / Self-Pay

$3,937

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,579

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: $3,937 (1105%)

Insurance Median: $3,579 (1004%)

Cash: $3,937 (1105% of Medicare)

Ins. Median: $3,579 (1004% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 1004% of the Medicare baseline (a markup of 904%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Empire	$65 - $273	18%
Blue Cross Blue Shield	$353 - $19,744	99%
Fidelis	$374	105%
Humana	$423 - $5,857	119%
Tricare	$423	119%
Amerihealth Caritas Mcr Adv - All Plans	$427	120%
UnitedHealthcare	$1,217 - $6,834	341%
Fidelis Care - Exchange - All Plans	$3,579	1004%
Geisinger - All Plans	$3,787	1062%
Cigna	$4,055	1138%
Mvp Health Plan - All Plans	$4,055	1138%
Independent Health - All Plans	$4,230	1187%
Upmc - All Plans	$4,491	1260%
Pomco Inc - All Plans	$4,686	1315%
Aetna	$4,881 - $5,809	1369%
Emblem Health - All Plans	$5,727	1607%
Emblem/Ghi	$6,014	1687%
Martins Point - All Plans	$6,508	1826%
Healthnow - All Plans	$21,436	6014%

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 $3,937.
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 Ira Davenport 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.