CT abdomen and pelvis with contrast at CHI Health Missouri Valley. CPT 74177.
What CHI Health Missouri Valley publishes for this service, straight from its standard-charges file, last updated February 28, 2026.
Outpatient / ER
$3,429cash price (self-pay)
$6,998list price
$2,449–$6,858range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Humana | Medicare|All Plans | $2,449 |
| Medica | Medicare|All Plans | $2,449 |
| PACE | Medicare|All Plans | $2,449 |
| United | Medicare|All Plans | $2,449 |
| Centene | Medicare|All Plans | $2,498 |
| Amerigroup | Medicare|All Plans | $2,572 |
| Great Plains | Medicare|All Plans | $2,572 |
| BCBS - NE | Commercial|BluePrint | $2,650 |
| BCBS - NE | Commercial|All Other Plans | $2,789 |
| United | Medicaid|Community Plan | $3,009 |
| Amerigroup | Medicaid|All Plans | $3,069 |
| Total Care | Medicaid|All Plans | $3,069 |
| IAMolina | Medicaid|All Plans | $3,130 |
| AMPS | Commercial|All Plans | $5,437 |
| Medica | Commercial|All Other Plans | $6,368 |
| Medica | Commercial|CHI Health | $6,368 |
| Greater Omaha Packing | Commercial|Broad Network | $6,718 |
| Greater Omaha Packing | Commercial|Narrow Network | $6,718 |
| Medica | Commercial|ACO | $6,718 |
| Medica | Commercial|Open Access | $6,718 |
| Midlands Choice | Commercial|Premier | $6,718 |
| Midlands Choice | Commercial|Standard | $6,718 |
| Millard Public Schools | Commercial|Broad Network | $6,718 |
| Millard Public Schools | Commercial|Narrow Network | $6,718 |
| One World | Commercial|Broad Network | $6,718 |
| One World | Commercial|Narrow Network | $6,718 |
| QuikTrip | Commercial|All Plans | $6,718 |
| Timpte | Commercial|Broad Network | $6,718 |
| United | Commercial|All Plans | $6,718 |
| MultiPlan | Commercial|All Plans | $6,858 |
Inpatient
$3,429cash price (self-pay)
$6,998list price
$3,989–$6,858range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Wellmark | Commercial|HMO | $3,989 |
| Wellmark | Commercial|PPO | $3,989 |
| BCBS - NE | Commercial|BluePrint | $6,316 |
| Medica | Commercial|All Other Plans | $6,368 |
| Medica | Commercial|CHI Health | $6,368 |
| BCBS - NE | Commercial|All Other Plans | $6,648 |
| Greater Omaha Packing | Commercial|Broad Network | $6,718 |
| Greater Omaha Packing | Commercial|Narrow Network | $6,718 |
| Medica | Commercial|ACO | $6,718 |
| Medica | Commercial|Open Access | $6,718 |
| Midlands Choice | Commercial|Premier | $6,718 |
| Midlands Choice | Commercial|Standard | $6,718 |
| Millard Public Schools | Commercial|Broad Network | $6,718 |
| Millard Public Schools | Commercial|Narrow Network | $6,718 |
| One World | Commercial|Broad Network | $6,718 |
| One World | Commercial|Narrow Network | $6,718 |
| QuikTrip | Commercial|All Plans | $6,718 |
| Timpte | Commercial|Broad Network | $6,718 |
| United | Commercial|All Plans | $6,718 |
| MultiPlan | Commercial|All Plans | $6,858 |
| PHCS | Commercial|All Plans | $6,858 |
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