CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Stonewall Jackson Memorial Hospital

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74177
Insurance Median: $1,867
Cash Discount Price: $1,059
vs. Medicare Baseline: 5.24x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Stonewall Jackson Memorial Hospital is $1,867. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,059. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 5.24x the Medicare baseline. Located in 230 Hospital Plaza, Weston, WV.

Cash / Self-Pay

$1,059

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,867

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: $1,059 (297%)

Insurance Median: $1,867 (524%)

Cash: $1,059 (297% of Medicare)

Ins. Median: $1,867 (524% 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 524% of the Medicare baseline (a markup of 424%). 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
Medicaid / KanCare	$210 - $215	59%
Blue Cross Blue Shield	$221 - $1,623	62%
Aetna	$280 - $1,694	79%
Humana	$343	96%
Umwa	$343	96%
Ves	$343	96%
Universal_Health	$354	99%
Onenet	$1,828	513%
Healthsmart_Accel	$1,906	535%
Healthsmart_Auto	$1,906	535%
Healthsmart_Hpo	$1,906	535%
Healthsmart_Ppo	$1,906	535%
Sharpe	$1,906	535%
Cigna	$1,910	536%
UnitedHealthcare	$1,970	553%
Alliance_Ppo	$2,012	564%
Ccn	$2,012	564%
Multiplan	$2,012	564%
Napp	$2,065	579%
4_Most	$2,076	582%

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 $1,059.
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 Stonewall Jackson 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.