CT abdomen and pelvis with contrast at INDIANA ORTHOPAEDIC HOSPITAL LLC Northwest. CPT 74177.
What INDIANA ORTHOPAEDIC HOSPITAL LLC Northwest publishes for this service, straight from its standard-charges file, last updated June 10, 2026.
Outpatient / ER
$1,104cash price (self-pay)
$4,481list price
$736–$3,899range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aarp | Aarp | $736 |
| Aarp Medicare Complete | Aarp Medicare Complete | $736 |
| Aarp Medicare Complete Aarp Medicare Complete Via United | Aarp Medica | $736 |
| Aarp Medicare Complete/Wellmed Wellmed As Payor | Aarp Medicare Comple | $736 |
| Aarp Medicare Supplement Plan | Aarp Medicare Supplement Plan | $736 |
| Aarp Medicarecomplete Choice PPO | Aarp Medicarecomplete Choice PPO | $736 |
| Aarp Po 740819 | Aarp Po 740819 | $736 |
| Aarp Select Aarp Select Plan C & F | Aarp Select Aarp Select Plan C | $736 |
| Aarp Supplemental | Aarp Supplemental | $736 |
| Aetna Medicare Advantage | Aetna Medicare Advantage | $736 |
| Aetna Medicare HMO Aetna Golden Medicare Choice | Aetna Medicare HMO A | $736 |
| Aetna Medicare PPO Aetna Medicare | Aetna Medicare PPO Aetna Medicare | $736 |
| Aetna Medicare PPO Esa Aetna Medicare With Esa On Id Card | Aetna Medi | $736 |
| Aetna Medicare Uaw Esa Uaw Members With Esa On Id Card | Aetna Medicar | $736 |
| Aetna Medicare Uaw PPO Uwa Members With PPO Plan | Aetna Medicare Uaw | $736 |
| Aetna Senior Supplemental | Aetna Senior Supplemental | $736 |
| Aetna Senior Supplemental Insurance | Aetna Senior Supplemental Insura | $736 |
| Allwell - Mhs Mhs - Allwell | Allwell - Mhs Mhs - Allwell | $736 |
| Anthem Healthy Indiana Health Indiana Plan - Anthem | Anthem Healthy I | $736 |
| Anthem Hhw - St. Francis St Francis Only | Anthem Hhw - St. Francis St | $736 |
| Anthem Hip - St. Francis St. Francis Only | Anthem Hip - St. Francis S | $736 |
| All Savers | All Savers | $974 |
| Anthem BCBS Hpn Blue High Performance Network (Hpn) | Anthem BCBS Hp | $1,126 |
| Anthem BCBS Anthem Enhanced Choice (Prefix E7b) | Anthem BCBS Anthem E | $1,126 |
| Anthem Blue Cross And Blue Shield | Anthem Blue Cross And Blue Shield | $1,126 |
| Anthem Geoblue BCBS International Plan | Anthem Geoblue BCBS Internati | $1,126 |
| Anthem HMO Blue Preferred | Anthem HMO Blue Preferred | $1,126 |
| Allegiance | Allegiance | $1,196 |
| Ambetter | Ambetter | $1,288 |
| Ambetter - Mhs Ambetter | Ambetter - Mhs Ambetter | $1,288 |
Inpatient
$58,783cash price (self-pay)
$130,303list price
$2,319–$130,303range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem Blue Cross And Blue Shield | Anthem Blue Cross And Blue Shield | $2,441 |
| Anthem HMO Blue Preferred | Anthem HMO Blue Preferred | $2,441 |
| Aetna | Aetna | $3,329 |
| Aetna Open Access | Aetna Open Access | $3,329 |
| Aetna Apcn Apcn - Aetna Premium Care Network | Aetna Apcn Apcn - Aet | $3,329 |
| Aetna HMO Aetna Choice POS | Aetna HMO Aetna Choice POS | $3,329 |
| Aetna HMO Aetna Select | Aetna HMO Aetna Select | $3,329 |
| Aetna HMO Managed Choice HMO | Aetna HMO Managed Choice HMO | $3,329 |
| Aetna PPO Nap (National Advantage Program) | Aetna PPO Nap (National A | $3,329 |
| Aetna PPO Open Choice PPO | Aetna PPO Open Choice PPO | $3,329 |
| Aetna PPO Signature Administrators | Aetna PPO Signature Administrator | $3,329 |
| Aarp | Aarp | $39,189 |
| Aarp Medicare Complete | Aarp Medicare Complete | $39,189 |
| Aarp Medicare Complete Aarp Medicare Complete Via United | Aarp Medica | $39,189 |
| Aarp Medicare Complete/Wellmed Wellmed As Payor | Aarp Medicare Comple | $39,189 |
| Aarp Medicare Supplement Plan | Aarp Medicare Supplement Plan | $39,189 |
| Aarp Medicarecomplete Choice PPO | Aarp Medicarecomplete Choice PPO | $39,189 |
| Aarp Po 740819 | Aarp Po 740819 | $39,189 |
| Aarp Select Aarp Select Plan C & F | Aarp Select Aarp Select Plan C | $39,189 |
| Aarp Supplemental | Aarp Supplemental | $39,189 |
| Aetna Medicare Advantage | Aetna Medicare Advantage | $39,189 |
| Aetna Medicare HMO Aetna Golden Medicare Choice | Aetna Medicare HMO A | $39,189 |
| Aetna Medicare PPO Aetna Medicare | Aetna Medicare PPO Aetna Medicare | $39,189 |
| Aetna Medicare PPO Esa Aetna Medicare With Esa On Id Card | Aetna Medi | $39,189 |
| Aetna Medicare Uaw Esa Uaw Members With Esa On Id Card | Aetna Medicar | $39,189 |
| Aetna Medicare Uaw PPO Uwa Members With PPO Plan | Aetna Medicare Uaw | $39,189 |
| Aetna Senior Supplemental | Aetna Senior Supplemental | $39,189 |
| Aetna Senior Supplemental Insurance | Aetna Senior Supplemental Insura | $39,189 |
| Allwell - Mhs Mhs - Allwell | Allwell - Mhs Mhs - Allwell | $39,189 |
| Anthem Healthy Indiana Health Indiana Plan - Anthem | Anthem Healthy I | $39,189 |
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All common services at INDIANA ORTHOPAEDIC HOSPITAL LLC Northwest