CMS Price Transparency Data

CT scan, abdomen and pelvis (no contrast)

Facility: Gundersen Moundview Hospital and Clinics

Billing Code: 74176 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74176
Insurance Median: $2,001
Cash Discount Price: $2,053
vs. Medicare Baseline: 8.21x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (no contrast) at Gundersen Moundview Hospital and Clinics is $2,001. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,053. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 8.21x the Medicare baseline. Located in 402 W Lake St, Friendship, WI.

Cash / Self-Pay

$2,053

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,001

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: $2,053 (842%)

Insurance Median: $2,001 (821%)

Cash: $2,053 (842% of Medicare)

Ins. Median: $2,001 (821% 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 821% of the Medicare baseline (a markup of 721%). 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
Amerigroup	$138	57%
Blue Cross Blue Shield	$990 - $2,462	406%
Iowa Total Care	$990	406%
Managed Health Service	$990	406%
Dean Health Plan	$1,192	489%
UnitedHealthcare	$1,221	501%
Health Partners	$1,841 - $3,534	755%
Security Health Plan	$1,841	755%
Ucare	$1,841 - $3,202	755%
Quartz	$2,181	895%
Wps	$3,085	1266%
Wps - Arise	$3,085	1266%
Alliance	$3,202 - $3,802	1314%
Aspirus Arise Health	$3,322	1363%
Humana	$3,402	1396%
Multiplan/Healtheos	$3,522 - $3,842	1445%
Coventry Health Care	$3,802	1560%

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 $2,053.
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 Gundersen Moundview Hospital and Clinics 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.