CT abdomen and pelvis with contrast at Audubon County Memorial Hospital. CPT 74177.
What Audubon County Memorial Hospital publishes for this service, straight from its standard-charges file, last updated September 14, 2026.
Outpatient / ER
$2,000cash price (self-pay)
$2,000list price
$832–$1,960range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Wellmark HMO | Wellmark HMO | $832 |
| Wellmark PPO - All Other Plans | Wellmark PPO - All Other Plans | $917 |
| UHC All Payer - All Plans | UHC All Payer - All Plans | $1,200 |
| Aetna Mcr Adv | Aetna Mcr Adv | $1,440 |
| Tricare - All Plans | Tricare - All Plans | $1,440 |
| Aetna Comm - All Other Plans | Aetna Comm - All Other Plans | $1,800 |
| Molina Mcaid - All Plans | Molina Mcaid - All Plans | $1,800 |
| Iowa Total Care Mcaid - All Plans | Iowa Total Care Mcaid - All Plans | $1,818 |
| Amerigroup Mcaid - All Plans | Amerigroup Mcaid - All Plans | $1,890 |
| Midlands Choice - All Plans | Midlands Choice - All Plans | $1,960 |
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