CT abdomen and pelvis with contrast at Sioux Valley Memorial Hospital Association. CPT 74177.
What Sioux Valley Memorial Hospital Association publishes for this service, straight from its standard-charges file, last updated March 31, 2026.
Outpatient / ER
$4,008cash price (self-pay)
$4,453list price
$2,360–$2,449range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| HEALTH PARTNERS | Medicare | $2,360 |
| WellPoint | Medicare | $2,360 |
| Molina | Medicaid | $2,449 |
Inpatient
$4,008cash price (self-pay)
$4,453list price
$4,214–$4,453range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Admin Concepts | Commercial | $4,214 |
| AETNA | Commercial | $4,214 |
| AETNA | Medicare | $4,214 |
| American Republic | Commercial | $4,214 |
| APW | All Plans | $4,214 |
| Auxiant | Commercial | $4,214 |
| Avera | Commercial | $4,214 |
| Bankers Life | Commercial | $4,214 |
| BLUE CROSS | Commercial | $4,214 |
| BLUE CROSS | Medicare | $4,214 |
| CHAMPUS | Commercial | $4,214 |
| CIGNA | Commercial | $4,214 |
| HEALTH PARTNERS | Commercial | $4,214 |
| HEALTH PARTNERS | Medicare | $4,214 |
| HUMANA | Medicare | $4,214 |
| Iowa Total Care | Commercial | $4,214 |
| Liability | Commercial | $4,214 |
| MERIDIAN | Commercial | $4,214 |
| MERITAIN | Commercial | $4,214 |
| MIDLANDS | Commercial | $4,214 |
| MOLINA | Commercial | $4,214 |
| Mutual of Omaha | Commercial | $4,214 |
| Occunet | Commercial | $4,214 |
| PHYSICIANS MUTUAL | Commercial | $4,214 |
| Private Healthcare | Commercial | $4,214 |
| Sanford | Commercial | $4,214 |
| UHC | Commercial | $4,214 |
| UHC | Medicare | $4,214 |
| UMR | Commercial | $4,214 |
| United American | Commercial | $4,214 |
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All common services at Sioux Valley Memorial Hospital Association