CT abdomen and pelvis with contrast at Community Hospital of Bremen. CPT 74177.
What Community Hospital of Bremen publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$2,587cash price (self-pay)
$3,980list price
$632–$5,173range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem | IN Medicaid HCC | $632 |
| Anthem | IN Medicaid HIP | $632 |
| Humana | Pathways for Aging | $632 |
| MHS | IN Medicaid HHW | $632 |
| MHS | IN Medicaid HIP | $632 |
| MdWise | IN Medicaid HHW | $632 |
| MdWise | IN Medicaid HIP | $632 |
| UHC | Pathways for Aging | $632 |
| Anthem | Exchange | $933 |
| Aetna | Medicare Advantage | $1,234 |
| Anthem | Medicare Advantage | $1,234 |
| Anthem | Workers Compensation | $1,234 |
| Caresource | Exchange | $1,234 |
| Humana | Medicare Advantage | $1,234 |
| MHS | Exchange | $1,234 |
| UHC | Medicare Advantage | $1,234 |
| VA Optum | VA | $1,234 |
| Anthem | Pathway Essentials | $1,592 |
| Plain Church | Commercial | $1,592 |
| Immergrun | Commercial | $1,990 |
| Anthem | Commercial PPO | $2,181 |
| Anthem | Commercial Trad | $2,395 |
| Cigna Sagamore | Commercial | $2,766 |
| Cigna Sagamore | PPO | $2,766 |
| CHA | Employer Group 4 | $2,786 |
| Caresource | IN Medicaid HIP | $2,903 |
| Medishare Multiplan | Commercial | $2,985 |
| PHP | Commercial | $2,985 |
| Priority Health | Commercial | $2,985 |
| Aetna | Commercial | $3,009 |
Inpatient
$2,587cash price (self-pay)
$3,980list price
$1,990–$5,173range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Immergrun | Commercial | $1,990 |
| Anthem | Commercial PPO | $2,116 |
| Anthem | Commercial Trad | $2,397 |
| Cigna Sagamore | Commercial | $2,766 |
| Cigna Sagamore | PPO | $2,766 |
| CHA | Employer Group 4 | $2,786 |
| Medishare Multiplan | Commercial | $2,985 |
| PHP | Commercial | $2,985 |
| Priority Health | Commercial | $2,985 |
| Aetna | Commercial | $3,009 |
| Allied Benefit | Commercial | $3,009 |
| CHA | Commercial | $3,064 |
| Multiplan | Commercial | $3,184 |
| Plain Church | Commercial | $3,184 |
| Cigna Prof Benefit | Commercial | $3,263 |
| Caresource | IN Medicaid HIP | $5,173 |
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