CT abdomen and pelvis with contrast at Ascension St. Vincent Clay (St. Vincent Clay Hospital, Inc.). CPT 74177.
What Ascension St. Vincent Clay (St. Vincent Clay Hospital, Inc.) publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$2,623cash price (self-pay)
$4,372list price
$65.14–$2,942range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem Care Connect | 8255_anthem Connect Medicaid Replacement Outpat | $157 |
| Anthem Care Connect | 8879_anthem Connect Medicaid Replacement Asc Out | $157 |
| Anthem Medicaid | 7373_anthem Medicaid Replacement Outpatient 20230101 | $157 |
| Mdwise Hoosier Alliance Medicaid | 8256_mdwise Medicaid Replacement Ou | $157 |
| Mdwise Hoosier Alliance Medicaid | 9347_mdwise Medicaid Replacement As | $157 |
| Medicaid Advantage | 8723_medicaid Replacement Outpatient 20240401 | $157 |
| Medicaid Replacement Asc Outpatient 20250101 | 9365_medicaid Replaceme | $157 |
| Mhs Care Connect | 8257_mhs Connect Medicaid Replacement Outpatient 2 | $157 |
| Mhs Care Connect | 8877_mhs Connect Medicaid Replacement Asc Outpatien | $157 |
| Aetna Mcr | 8946_aetna Medicare Replacement Asc Outpatient Asin, Ecin, | $233 |
| Aetna Mcr Choice | 8955_aetna Choice Medicare Replacement Asc Outpatie | $233 |
| Anthem Mcr | 8964_anthem Medicare Replacement Asc Outpatient Asin, Eci | $233 |
| Ascension Complete Mcr | 9108_ascension Complete Medicare Replacement | $233 |
| Caresource HMO Medicare Advantage | 8973_caresource HMO Medicare Repla | $233 |
| Caresource Marketplace | 9054_caresource Marketplace Medicare Replacem | $233 |
| Corizon | 9072_corizon Medicare Replacement Asc Outpatient Asin, Ecin, | $233 |
| Humana Gold Mcr | 9000_humana Gold Choice Medicare Replacement Asc Out | $233 |
| Humana Mcr Choice | 8991_humana Choice Medicare Replacement Asc Outpat | $233 |
| UHC | 9470_united Healthcare Vein 20250101 | $244 |
| UHC Self | 6575_united Health Care Self Funded Non-Contracted Vein 202 | $244 |
| UHC | 9384_united Healthcare Clin 20250101 | $316 |
| Anthem Healthsync HMO | 9399_anthem Healthsync HMO Vein 20250101 | $444 |
| Anthem Healthsync POS | 9401_anthem Healthsync POS Vein 20250101 | $444 |
| Anthem HMO/POS | 9403_anthem HMO POS Vein 20250101 | $444 |
| Anthem Pathway | 9404_anthem Pathway Vein 20250101 | $444 |
| Anthem Pathway X | 9405_anthem Pathway X Vein 20250101 | $444 |
| Anthem PPO Preferred | 9406_anthem Preferred Vein 20250101 | $444 |
| Anthem Short Term Limited Duration | 9407_anthem Short Term Limited Du | $444 |
| Anthem Traditional | 9408_anthem Traditional Vein 20250101 | $444 |
| Encore Exclusive | 9409_encore Excusive Vein 20250101 | $444 |
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All common services at Ascension St. Vincent Clay (St. Vincent Clay Hospital, Inc.)