CT abdomen and pelvis with contrast at Madison County Memorial Hospital. CPT 74177.
What Madison County Memorial Hospital publishes for this service, straight from its standard-charges file, last updated September 23, 2026.
Outpatient / ER
$3,195cash price (self-pay)
$3,994list price
$1,042–$3,994range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Wellmark BCBS HMO | Wellmark BCBS HMO | $1,042 |
| Wellmark BCBS PPO - All Other Plans | Wellmark BCBS PPO - All Other Pl | $1,146 |
| Medical Associates Hp - All Plans | Medical Associates Hp - All Plans | $1,717 |
| Aetna Mcr Adv | Aetna Mcr Adv | $1,717 |
| Medigold-All Plans | Medigold-All Plans | $1,717 |
| Tricare/Hnfs - All Plans | Tricare/Hnfs - All Plans | $1,717 |
| UHC Mcr Adv | UHC Mcr Adv | $1,717 |
| American Hp Mcr Adv-All Plans | American Hp Mcr Adv-All Plans | $1,803 |
| UHC Mcaid | UHC Mcaid | $1,877 |
| Iowa Total Care Mcaid-All Plans | Iowa Total Care Mcaid-All Plans | $1,877 |
| Molina Mcaid/Chip -All Plans | Molina Mcaid/Chip -All Plans | $1,943 |
| Amerigroup Mcaid-All Plans | Amerigroup Mcaid-All Plans | $1,990 |
| Madison County Sheriff-All Plans | Madison County Sheriff-All Plans | $1,997 |
| Oscar - All Plans | Oscar - All Plans | $2,576 |
| Aetna-All Other Plans | Aetna-All Other Plans | $2,596 |
| UHC-All Other Plans | UHC-All Other Plans | $3,595 |
| Corvel Wc-All Plans | Corvel Wc-All Plans | $3,595 |
| Choicecare-All Plans | Choicecare-All Plans | $3,794 |
| First Choice-All Plans | First Choice-All Plans | $3,794 |
| Plaines Health-All Plans | Plaines Health-All Plans | $3,794 |
| First Health-All Plans | First Health-All Plans | $3,794 |
| Integrated Hp-All Plans | Integrated Hp-All Plans | $3,794 |
| Mutual Of Omaha-All Plans | Mutual Of Omaha-All Plans | $3,794 |
| Preferred Hlth Ntwork-All Plans | Preferred Hlth Ntwork-All Plans | $3,794 |
| Principal Healthcare-All Plans | Principal Healthcare-All Plans | $3,794 |
| Usa Managed Care-All Plans | Usa Managed Care-All Plans | $3,794 |
| Medimore Employee Hp - All Plans | Medimore Employee Hp - All Plans | $3,914 |
| Midlands Choice - All Plans | Midlands Choice - All Plans | $3,914 |
| Benefit Admin Of America-All Plans | Benefit Admin Of America-All Plan | $3,994 |
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