CMS Price Transparency Data

CT scan, abdomen and pelvis (no contrast)

Facility: Bellin Memorial Hospital

Billing Code: 74176 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74176
Insurance Median: $654
Cash Discount Price: $607
vs. Medicare Baseline: 2.68x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (no contrast) at Bellin Memorial Hospital is $654. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $607. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 2.68x the Medicare baseline. Located in 744 S Webster Ave, Green Bay, WI.

Cash / Self-Pay

$607

Average discount available for prompt cash payment at this facility.

Insurance Median

$654

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)

Cash / Self-Pay: $607 (249%)

Insurance Median: $654 (268%)

Cash: $607 (249% of Medicare)

Ins. Median: $654 (268% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 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 268% of the Medicare baseline (a markup of 168%). 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
Aetna	$224 - $241	92%
Community Care	$224 - $525	92%
Humana	$224 - $525	92%
My Choice	$224 - $241	92%
Network Health	$230 - $1,628	94%
UnitedHealthcare	$233 - $936	96%
Blue Cross Blue Shield	$241 - $703	99%
Common Ground	$560	230%
Chorus Community Health Plan	$601	247%
Aspirus Arise	$645 - $673	265%
Cigna	$658 - $666	270%
Wps Insurance	$681 - $794	279%
Hps/Paymedix	$691 - $747	283%
Trilogy	$710	291%
Healthsmart	$747	306%
Ihs(Claimsbridge)	$747	306%
Medical College Of Wi	$747	306%
Multiplan	$747	306%
Allied National	$794	326%
First Health	$794	326%
Galaxy Health	$794	326%
Three Rivers Provider Network	$841	345%

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 $607.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 74176.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Bellin Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 74176.
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.