CT abdomen and pelvis with contrast at Ascension Saint Alexius Women And Children's Hospital (Ascension St. Alexius Medical Center). CPT 74177.
What Ascension Saint Alexius Women And Children's Hospital (Ascension St. Alexius Medical Center) publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
—cash price (self-pay)
—list price
$354–$2,557range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aarp | 1687_medicare Advantage Aarp Outpatient (Ab,Sa) 20240101 | $354 |
| UHC Mcr HMO 95% | 1695_medicare Advantage UHC Outpatient (Ab,Sa) 95% 2 | $354 |
| Aetna Medicare | 1689_medicare Advantage Aetna Outpatient (Ab,Sa) 2024 | $372 |
| BCBS Medicare | 1690_medicare Advantage BCBS Outpatient (Ab,Sa) 202401 | $372 |
| Covid-19 Uninsured | 1702_covid-19 Uninsured (Ab,Sa) Outpatient 202401 | $372 |
| Humana Medicare | 1691_medicare Advantage Humana Outpatient (Ab,Sa) 20 | $372 |
| Medicare Replacement 100% | 1686_medicare Advantage 100% Outpatient (A | $372 |
| UHC Medicare 100% | 1694_medicare Advantage UHC Outpatient (Ab,Sa) 100 | $372 |
| Illinicare Medicare Replacement | 1692_medicare Advantage Illinicare O | $383 |
| Molina Healthcare Of Illinois | 1693_medicare Advantage Molina Hc Of I | $383 |
| Aetna Better Health Medicare Replacement | 1688_medicare Advantage Aet | $391 |
| Bright Health | 1684_bright Health (Ab,Sa) Outpatient 20240101 | $465 |
| BCBS Focus Care | 1699_blue Cross Blue Shield Focus Care (Sa) Outpatie | $488 |
| Smarthealth | 1696_smarthealth (Ab,Sa) Outpatient 20240101 | $521 |
| Aetna HMO | 1717_aetna HMO (Ab,Sa) 20240101 | $570 |
| Actin Care | 1682_actin Care 155%Mcr (Ab,Sa) Outpatient 20240101 | $577 |
| Ambetter | 1683_ambetter (Ab,Sa) Outpatient 20240101 | $603 |
| BCBS Bcs | 1701_blue Cross Blue Shield Bcs (Sa) Outpatient 20240101 | $659 |
| Humana PPO | 1622_humana PPO (Sa) 20231001 | $1,149 |
| Humana HMO | 1620_humana HMO (Sa) 20231001 | $1,156 |
| Cigna Ifp | 1616_cigna Ifp (Sa) 20231001 | $2,413 |
| Cigna | 1614_cigna (Ab,Sa) 20231001 | $2,507 |
| Cigna C5 | 1298_cigna C5 (Ab,Sa) 20230201 | $2,507 |
| Cigna Local Plus | 1714_cigna Local Plus (Ab,Sa) 20240101 | $2,507 |
Inpatient
—cash price (self-pay)
—list price
$354–$2,557range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aarp | 1655_medicare Advantage Aarp (Ab,Sa) Inpatient 20231001 | $354 |
| UHC Mcr HMO 95% | 1663_medicare Advantage UHC Inpatient (Ab,Sa) 95% 20 | $354 |
| Aetna Medicare | 1657_medicare Advantage Aetna Inpatient (Ab,Sa) 20231 | $372 |
| BCBS Medicare | 1733_medicare Advantage BCBS Inpatient (Ab,Sa) 2024010 | $372 |
| Covid-19 Uninsured | 1652_covid-19 Uninsured (Ab,Sa) Inpatient 2023100 | $372 |
| Humana Medicare | 1659_medicare Advantage Humana Inpatient (Ab,Sa) 202 | $372 |
| Medicare Replacement 100% | 1654_medicare Advantage 100% (Ab,Sa) Inpat | $372 |
| UHC Medicare 100% | 1661_medicare Advantage UHC Inpatient 100% (Ab,Sa) | $372 |
| UHC Medicare 101% | 1662_medicare Advantage UHC Inpatient (Ab,Sa) 101% | $376 |
| Illinicare Medicare Replacement | 1660_medicare Advantage Illinicare I | $383 |
| Molina Healthcare Of Illinois | 1645_medicare Advantage Molina Hc Of I | $383 |
| Aetna Better Health Medicare Replacement | 1656_medicare Advantage Aet | $391 |
| Bright Health | 1648_bright Health (Ab,Sa) Inpatient 20231001 | $465 |
| BCBS Focus Care | 1732_blue Cross Blue Shield Focus Care (Sa) Inpatien | $488 |
| BCBS Bcs | 1728_blue Cross Blue Shield Bcs (Sa) Inpatient 20240101 | $491 |
| Smarthealth | 1643_smarthealth (Ab,Sa) Inpatient 20231001 | $521 |
| Actin Care | 1650_actin Care 155%Mcr (Ab,Sa) Inpatient 20231001 | $577 |
| Ambetter | 1646_ambetter (Ab,Sa) Inpatient 20231001 | $603 |
| Aetna Better Health | 1744_medicaid Advantage Aetna Better Health (Sa) | $2,557 |
| BCBS Medicaid | 1746_medicaid Advantage BCBS (Sa) 20240101 | $2,557 |
| County Care | 1747_medicaid Advantage County Care (Sa) 20240101 | $2,557 |
| Harmony Health Plan | 1753_medicaid Advantage Harmony Health Plan (Sa) | $2,557 |
| Illinicare | 1756_medicaid Advantage Illinicare (Sa) 20240101 | $2,557 |
| Medicaid Replacement 100% | 1760_medicaid Advantage Other (Sa) 2024010 | $2,557 |
| Meridian | 1758_medicaid Advantage Meridian (Sa) 20240101 | $2,557 |
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