CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Black River Memorial Hospital

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74177
Insurance Median: $2,111
Cash Discount Price: $3,726
vs. Medicare Baseline: 5.92x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Black River Memorial Hospital is $2,111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,726. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 5.92x the Medicare baseline. Located in 711 W Adams St, Black River Falls, WI.

Cash / Self-Pay

$3,726

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,111

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: $3,726 (1045%)

Insurance Median: $2,111 (592%)

Cash: $3,726 (1045% of Medicare)

Ins. Median: $2,111 (592% 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 592% of the Medicare baseline (a markup of 492%). 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
Blue Cross Blue Shield	$58 - $2,175	16%
Group Health Cooperative Of Eau Claire	$58 - $4,136	16%
My Choice Wisconsin, Inc.	$58 - $2,175	16%
Quartz Health Solutions, Inc	$58 - $3,880	16%
UnitedHealthcare	$58 - $4,021	16%
Multiplan	$67 - $4,221	19%
Humana	$80 - $3,966	22%
Corvel	$819 - $2,601	230%
Security Health Plan	$1,125 - $3,983	316%
The Alliance	$1,142 - $4,093	320%
Triology Health Solutions	$1,209 - $4,051	339%
Medica	$1,254 - $3,983	352%
Association Benefits Solution	$1,276 - $4,051	358%
Family Health Center Of Marshfield	$1,276 - $4,051	358%
First Health Group Corporation	$1,276 - $4,051	358%
Provider Network Of America	$1,276 - $4,051	358%
Cigna	$1,303 - $4,136	366%
Cofinity	$1,303 - $4,136	366%
Coventry Health Care	$1,303 - $4,136	366%
Custom Benefit Administrators	$1,303 - $4,136	366%
Healthpartners, Inc.	$1,303 - $4,136	366%
Wisconsin Physicians Service Insurance Corp	$1,303 - $4,136	366%
Chorus	$1,316 - $4,179	369%

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 $3,726.
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 Black River 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.