CT abdomen and pelvis with contrast at Dodge County Hospital Authority. CPT 74177.
What Dodge County Hospital Authority publishes for this service, straight from its standard-charges file, last updated May 14, 2026.
Outpatient / ER
—cash price (self-pay)
$5,408list price
$1.00–$4,867range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| UHC Commercial | PPO | $1.00 |
| Aetna Medicare Advantage | HMO | $304 |
| UHC Medicare Advantage | HMO | $304 |
| Humana Medicare PPO | PPO | $304 |
| BCBS Pathway/HMO | HMO | $822 |
| Peach State Medicaid | HMO | $840 |
| Amerigroup Medicaid | PPO | $961 |
| BCBS PPO/Par | PPO | $1,018 |
| Aetna | PPO | $4,056 |
| Cigna | PPO | $4,867 |
Inpatient
—cash price (self-pay)
$5,408list price
$1.00–$2,885range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Cigna | PPO | $1.00 |
| UHC Commercial | PPO | $1.00 |
| Peach State Medicaid | HMO | $1.00 |
| BCBS PPO/Par | PPO | $2,244 |
| Amerigroup Medicaid | PPO | $2,885 |
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