CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: St Nicholas Hospital

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74177
Insurance Median: $1,123
Cash Discount Price: $3,017
vs. Medicare Baseline: 3.15x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at St Nicholas Hospital is $1,123. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,017. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 3.15x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.

Cash / Self-Pay

$3,017

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,123

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: $3,017 (846%)

Insurance Median: $1,123 (315%)

Cash: $3,017 (846% of Medicare)

Ins. Median: $1,123 (315% 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 315% of the Medicare baseline (a markup of 215%). 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
Blue Cross Blue Shield	$65 - $1,358	18%
Community Care Family Care	$65 - $130	18%
Managed Health Services	$65 - $130	18%
Medicaid / KanCare	$65 - $130	18%
Meridian Health Plan	$65 - $130	18%
Molina Healthcare	$69 - $345	19%
Triology	$69 - $3,611	19%
Security Health Plan	$139 - $2,918	39%
Aetna	$173 - $4,571	49%
Humana	$173 - $3,885	49%
Medica	$173 - $345	49%
Medicare (plans)	$173 - $345	49%
UnitedHealthcare	$173 - $1,184	49%
Naphcare	$388 - $777	109%
P360 Small Group	$1,123	315%
Prevea Health Network	$1,123	315%
Molina Healthcare Of Wi	$2,286	641%
Hshs Employees	$2,477	695%
Arise Health Plan	$2,743	770%
Wea Provider Network	$2,834 - $3,291	795%
Cigna	$3,200	898%
Interplan	$3,200	898%
Network Health Plan	$3,200	898%
Health Care Alliance	$3,337	936%
Health Eos	$3,428	962%
Healthsmart	$3,428	962%
Wisconsin Physician Service	$3,657	1026%
Multiplan/Phcs	$3,840	1077%
Choicecare	$3,885	1090%
North Central Healthcare Alliance	$4,205	1180%
First Health	$4,342	1218%
Caterpillar, Inc.	$4,571	1282%
Cofinity	$4,571	1282%
Live360	$4,571	1282%

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 $3,017.
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 St Nicholas 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.