CT abdomen and pelvis with contrast at West Suburban Medical Center. CPT 74177.
What West Suburban Medical Center publishes for this service, straight from its standard-charges file, last updated March 17, 2025.
Outpatient / ER
$1,225cash price (self-pay)
$8,625list price
$240–$5,606range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Cigna | All Commercial Plans | $240 |
| NALC | All Commercial Plans | $240 |
| Blue Cross | Blue Advantage MMAI | $361 |
| Humana | MMAI | $361 |
| Aetna | Medicare Advantage HMO/PPO | $372 |
| Ambetter | Marketplace | $372 |
| Blue Cross | Medicare Advantage | $372 |
| Cigna Healthspring | Medicare Advantage | $372 |
| Humana | Medicare Advantage Gold Plan | $372 |
| Longevity | Medicare Advantage | $372 |
| Wellcare | Medicare Advantage | $372 |
| Zing | Medicare Advantage | $372 |
| Oscar | Medicare Advantage | $380 |
| Blue Cross | PPO | $398 |
| Golden Rule | All Commercial Plans | $468 |
| United Healthcare | All Other Commercial Plans | $468 |
| United Healthcare | Navigate | $468 |
| Aetna | EPO/HMO/POS/PPO/Choice/NAP | $487 |
| Blue Cross | HMO | $1,280 |
| Blue Cross | Precision HMO | $1,434 |
| Aetna Rental Network | All Plans | $5,606 |
Inpatient
$1,225cash price (self-pay)
$8,625list price
$2,341–$5,606range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna Rental Network | All Plans | $5,606 |
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