CT abdomen and pelvis with contrast at Ely Bloomenson Community Hospital. CPT 74177.
What Ely Bloomenson Community Hospital publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$3,649cash price (self-pay)
$4,505list price
$741–$4,505range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medica Mcaid Mn Care | Medica Mcaid Mn Care | $741 |
| BCBS Mcaid | BCBS Mcaid | $1,540 |
| Hpi/Cigna Mn Care | Hpi/Cigna Mn Care | $2,162 |
| Medica Msho Mcr Cost/Select | Medica Msho Mcr Cost/Select | $2,176 |
| Medica Mcr Adv | Medica Mcr Adv | $2,253 |
| Tricare/Triwest - All Plans | Tricare/Triwest - All Plans | $2,478 |
| UHC Mcr Adv | UHC Mcr Adv | $2,478 |
| UHC Va Ccn | UHC Va Ccn | $2,478 |
| BCBS Mcr Adv | BCBS Mcr Adv | $2,478 |
| Hpi/Cigna Mcr Adv | Hpi/Cigna Mcr Adv | $2,478 |
| Humana Choicecare Mcr Adv | Humana Choicecare Mcr Adv | $2,503 |
| BCBS / Blue Plus - All Other Plans | BCBS / Blue Plus - All Other Plan | $3,709 |
| First Health - All Plans | First Health - All Plans | $3,829 |
| UHC All Payer - All Other Plans | UHC All Payer - All Other Plans | $3,973 |
| Americas PPO - All Plans | Americas PPO - All Plans | $4,009 |
| Medica Comm - All Other Plans | Medica Comm - All Other Plans | $4,113 |
| Hpi/Cigna Comm - All Other Plans | Hpi/Cigna Comm - All Other Plans | $4,370 |
| Hpi/Cigna Medicare Cost | Hpi/Cigna Medicare Cost | $4,370 |
| Humana Choicecare Comm - All Other Plans | Humana Choicecare Comm - Al | $4,415 |
| UHC Mcaid | UHC Mcaid | $4,505 |
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