CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Gundersen Moundview Hospital and Clinics

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74177
Insurance Median: $2,001
Cash Discount Price: $2,053
vs. Medicare Baseline: 5.61x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with 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 $356.43, this hospital’s rate is 5.61x 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

$356.43

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $356.43 (100%)

Cash / Self-Pay: $2,053 (576%)

Insurance Median: $2,001 (561%)

Cash: $2,053 (576% of Medicare)

Ins. Median: $2,001 (561% 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 561% of the Medicare baseline (a markup of 461%). 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	39%
Blue Cross Blue Shield	$990 - $4,968	278%
Iowa Total Care	$990	278%
Managed Health Service	$990	278%
UnitedHealthcare	$1,221	343%
Health Partners	$1,840 - $3,533	516%
Security Health Plan	$1,840	516%
Ucare	$1,840 - $3,201	516%
Dean Health Plan	$1,871	525%
Quartz	$2,181	612%
Wps	$3,084	865%
Wps - Arise	$3,084	865%
Alliance	$3,201 - $3,801	898%
Aspirus Arise Health	$3,321	932%
Humana	$3,401	954%
Multiplan/Healtheos	$3,521 - $3,841	988%
Coventry Health Care	$3,801	1066%

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: 74177.

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 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.