CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Bellin Memorial Hospital

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74177
Insurance Median: $1,030
Cash Discount Price: $953
vs. Medicare Baseline: 2.89x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Bellin Memorial Hospital is $1,030. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $953. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 2.89x the Medicare baseline. Located in 744 S Webster Ave, Green Bay, WI.

Cash / Self-Pay

$953

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,030

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: $953 (267%)

Insurance Median: $1,030 (289%)

Cash: $953 (267% of Medicare)

Ins. Median: $1,030 (289% 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 289% of the Medicare baseline (a markup of 189%). 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
Network Health	$339 - $1,628	95%
Aetna	$351 - $378	98%
Community Care	$351 - $824	98%
Humana	$351 - $824	98%
My Choice	$351 - $378	98%
UnitedHealthcare	$366 - $1,998	103%
Blue Cross Blue Shield	$378 - $1,143	106%
Common Ground	$880	247%
Chorus Community Health Plan	$943	265%
Aspirus Arise	$1,012 - $1,057	284%
Cigna	$1,034 - $1,045	290%
Wps Insurance	$1,070 - $1,246	300%
Hps/Paymedix	$1,085 - $1,173	304%
Trilogy	$1,114	313%
Healthsmart	$1,173	329%
Ihs(Claimsbridge)	$1,173	329%
Medical College Of Wi	$1,173	329%
Multiplan	$1,173	329%
Allied National	$1,246	350%
First Health	$1,246	350%
Galaxy Health	$1,246	350%
Three Rivers Provider Network	$1,319	370%

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 $953.
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 Bellin 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.