CT abdomen and pelvis with contrast at Franciscan Health Dyer. CPT 74177.
What Franciscan Health Dyer publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$1,490cash price (self-pay)
$5,520list price
$369–$5,520range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medicare [1099] | Medicare-Nir-Dyer | $369 |
| Medicare Replacement [2003] | Medicare-Nir-Dyer | $369 |
| Medicare [1099] | Medicare Part B [109992] | $369 |
| Medicare [1099] | Medicare Part A & B [109993] | $369 |
| Medicare Replacement [2003] | Wellcare Medicare Replacement [300390] | $369 |
| Medicare Replacement [2003] | United Healthcare Mc Replacement [300391 | $369 |
| Medicare Replacement [2003] | Humana Gold Plus Mc Replacement [300394] | $369 |
| Medicare Replacement [2003] | Cigna Healthspring Mc Replacement [30039 | $369 |
| Medicare Replacement [2003] | Anthem Bc Medicare Replacement [300396] | $369 |
| Medicare Replacement [2003] | Aetna Medicare Replacement [300397] | $369 |
| Blue Cross [1014] | Anthem Blue Access PPO-Cid | $552 |
| Medicaid Illinois [1091] | In Mcd-Nir-Dyer | $632 |
| Medicaid [1092] | In Mcd-Nir-Dyer | $632 |
| Mdwise [1175] | In Mcd-Nir-Dyer | $632 |
| Alt Traditional Medicaid Secondary [109200] | In Mcd-Nir-Dyer | $632 |
| Managed Health Services [1302] | In Mcd Dyer Mhs 112% Of In Mcd | $652 |
| Workers Comp [1172] | Workers Comp - Nir - Dyer | $738 |
| Medicaid [1092] | In Mcd Dyer Caresource 120% Of In Mcd | $759 |
| Cigna [1037] | Cigna Localplus-Nid | $850 |
| Blue Cross [1014] | Anthem Franciscan Employee Copps- All Locations | $893 |
| Blue Cross [1014] | Anthem Healthsync POS With Copps - Dyer | $1,052 |
| Blue Cross [1014] | Anthem Blue Access PPO With Copps - Dyer | $1,176 |
| Unicare [1150] | Anthem Blue Access PPO With Copps - Dyer | $1,176 |
| Blue Cross Illinois [1210] | Anthem Blue Access PPO With Copps - Dyer | $1,176 |
| Blue Cross Out Of State [1211] | Anthem Blue Access PPO With Copps - D | $1,176 |
| Alt Payer Illinois Blue Cross [121002] | Anthem Blue Access PPO With C | $1,176 |
| Alt Payer Indiana Blue Cross [121003] | Anthem Blue Access PPO With Co | $1,176 |
| Managed Care [2000] | Siho - Cid & Nid & Wid Locations | $1,658 |
| United Healthcare [1156] | UHC Nid-Hammond-Dyer-Munster-Crn Point | $1,793 |
| United Medical Resources [1158] | UHC Nid-Hammond-Dyer-Munster-Crn Poi | $1,793 |
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