CMS Price Transparency Data

CT scan, abdomen and pelvis (no contrast)

Facility: Fort Memorial Hospital

Billing Code: 74176 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74176
Insurance Median: $250
Cash Discount Price: $1,440
vs. Medicare Baseline: 1.03x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (no contrast) at Fort Memorial Hospital is $250. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,440. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 1.03x the Medicare baseline. Located in 611 Sherman Ave E, Fort Atkinson, WI.

Cash / Self-Pay

$1,440

Average discount available for prompt cash payment at this facility.

Insurance Median

$250

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: $1,440 (591%)

Insurance Median: $250 (103%)

Cash: $1,440 (591% of Medicare)

Ins. Median: $250 (103% 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.

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	$47 - $955	19%
Dean Health Plan	$55 - $1,529	23%
Quartz	$55 - $1,849	23%
UnitedHealthcare	$56 - $233	23%
Molina	$58 - $233	24%
Managed Health Services	$59 - $145	24%
Mercycare	$74 - $3,963	30%
Humana	$77 - $582	32%
Medicaid / KanCare	$133	55%
Aetna	$161 - $3,992	66%
Alliance	$212 - $3,820	87%
Medicare (plans)	$233	96%
Fort Care	$259 - $591	106%
Veteran Evaluation Services	$284	117%
Group Health Cooperative	$374 - $3,443	153%
Centivo	$396 - $1,050	162%
Trilogy	$718 - $4,681	295%
Cigna	$776 - $5,057	318%

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 $1,440.
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 Fort 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.