CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Fort Memorial Hospital

Billing Code: 74177 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$241

about 0.7× the $356 Medicare rate · typically $231–$368

modeled estimate · not a bill or quote

What this hospital charges insurers

$240

About the fair price

about $1 under the fair price · 0.7× Medicare

Medicare pays $356 Fair price $241 This hospital $240 Cash price $1,124 Hospital's list price $3,511

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

A typical price — 4 charge more and 4 charge less, among the 9 WI hospitals compared.

Cheapest $93 Priciest $300

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a CT scan, abdomen and pelvis (with contrast) is about $241 (about 0.7× the $356 Medicare rate). Fort Memorial Hospital charges insurers about $240, or about $1,124 in cash — about the fair price. Located in Fort Atkinson, WI.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$59 - $356	17%
Blue Cross Blue Shieldmajor	$49 - $955	14%
Aetnamajor	$168 - $2,968	47%
Cignamajor	$846 - $3,760	237%
Humanamajor	$80 - $635	22%
Dean Health Plan	$58 - $2,467	16%
Molina	$61 - $344	17%
Quartz	$58 - $3,033	16%
+ 8 smaller / regional plans	$62 - $3,480

Government programs also on file: Medicare, Medicaid.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 1,124), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 74177.

Insurance Before you use insurance

Call your insurance company to confirm Fort Memorial Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 74177.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Fort Memorial Hospital

Compare: CT scan, abdomen and pelvis (with contrast) at other WI hospitals

Insurance negotiated median for the same procedure, sorted lowest first.