CT abdomen and pelvis with contrast at Gundersen St. Elizabeth Hospital and Clinics. CPT 74177.
What Gundersen St. Elizabeth Hospital and Clinics publishes for this service, straight from its standard-charges file, last updated June 27, 2026.
Outpatient / ER
$1,895cash price (self-pay)
$3,112list price
$234–$2,988range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem | Medicaid | $234 |
| Group Health of South Central | Medicaid HMO | $234 |
| Iowa Total Care | Medicaid | $234 |
| Managed Health Service | Managed Medicaid | $234 |
| Quartz | Medicaid_Badgercare | $234 |
| South County | Managed Medicaid | $234 |
| Medica | AccessAbilty Solution | $491 |
| Medica | Minnesota Care | $491 |
| Bcbsmn | Mhcp | $770 |
| Quartz | All Products | $1,316 |
| Quartz | All Other Self Funded | $1,369 |
| Alliance | Premier/All Products | $1,426 |
| Alliance | Comprehensive/All Products | $1,426 |
| Quartz | Self Funded | $1,463 |
| Quartz | Level Funded | $1,509 |
| Health Partners | Medicaid HMO | $1,556 |
| Aetna | Medicare Advantage | $1,680 |
| Quartz | Fully Insured | $1,696 |
| Medica | Medicare Advantage | $1,712 |
| Health Partners | Medicare Cost | $1,867 |
| Anthem | Medicare HMO/PPO | $2,023 |
| Health Partners | Medicare Advantage | $2,023 |
| Humana | Medicare Advantage | $2,023 |
| Quartz | Medicare Advantage | $2,023 |
| South County | Managed Medicare | $2,023 |
| UCARE | Dually Eligible | $2,023 |
| UCARE | Non-Dually Eligible | $2,023 |
| BCBSMN | All Products | $2,142 |
| Group Health of South Central | All Products | $2,490 |
| Trilogy | All Products | $2,490 |
Inpatient
$1,895cash price (self-pay)
$3,112list price
$770–$2,988range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Quartz | All Other Self Funded | $1,833 |
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All common services at Gundersen St. Elizabeth Hospital and Clinics