CT abdomen and pelvis with contrast at New Ulm Medical Center. CPT 74177.
What New Ulm Medical Center publishes for this service, straight from its standard-charges file, last updated June 16, 2026.
Outpatient / ER
$1,589cash price (self-pay)
$2,838list price
$332–$2,838range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Cross Blue Shield of Minnesota | BC PMAP (N) | $332 |
| Allina Aetna Medicare (N) | Allina Aetna Medicare (N) | $342 |
| Medicare | Medicare (N) | $360 |
| Medica Health System | Medica PMAP (N) | $499 |
| UCare PMAP (A B C D E G N O S U R H) | UCare PMAP (ABDMNORSUV) | $571 |
| Blue Cross Blue Shield of Minnesota | BC State Health Plan (N) | $819 |
| BC AWARE/Blue Plus (NR) | BC AWARE/Blue Plus (NR) | $919 |
| Blue Cross Blue Shield of Minnesota | BC Premier(N) | $1,052 |
| BCBS | Bc Aehp (N) | $1,238 |
| Medicaid | Medicaid MA (N) | $1,242 |
| Medicare Other | All Other Medicare (N) | $1,257 |
| Medica | Medica Medicare (R) | $1,261 |
| Medica Health System | Medica Dual Solutions (R) | $1,277 |
| BCBS | BC Medicare (N) | $1,320 |
| Blue Cross Blue Shield of Minnesota | BC High Value/Performance Networ | $1,329 |
| All Other Medicaid | All Other Medicaid (N) | $1,362 |
| South Country Health Alliance | SCHA MSHO (N) | $1,405 |
| South Country Health Alliance | SCHA PMAP (N) | $1,471 |
| Aetna | Aetna Elevate (N R) | $1,756 |
| Aetna | Aetna Performance (N R) | $1,897 |
| Americas PPO (Araz)(B D N O R S V) | Americas PPO (Araz)(B D N O R S V | $2,189 |
| Medica UBH PMAP | Medica UBH PMAP (N) | $2,270 |
| Hpi-Cigna | Hpi Cigna (N) | $2,321 |
| Americas PPO (Araz) (B D N H O R S) | Americas PPO (Araz) (B D N H O R | $2,384 |
| First Health (A C E G H U B D N O R S) | First Health (ABDMNOSURV) | $2,384 |
| Medica UBH (N) | Medica UBH (N) | $2,384 |
| Aetna Direct/Indirect Network | Aetna Direct/Indirect Network (N R) | $2,425 |
| All Other Contracted Care (A B C D E G H N O R S U) | All Other Contra | $2,838 |
Inpatient
$1,589cash price (self-pay)
$2,838list price
$1,739–$2,838range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna | Aetna Elevate (N R) | $1,739 |
| Aetna | Aetna Performance (N R) | $1,879 |
| Medica UBH (N) | Medica UBH (N) | $1,987 |
| Americas PPO (Araz)(B D N O R S V) | Americas PPO (Araz)(B D N O R S V | $2,189 |
| Americas PPO (Araz) (B D N H O R S) | Americas PPO (Araz) (B D N H O R | $2,384 |
| First Health (A C E G H U B D N O R S) | First Health (ABDMNOSURV) | $2,384 |
| Aetna Direct/Indirect Network | Aetna Direct/Indirect Network (N R) | $2,400 |
| All Other Contracted Care (A B C D E G H N O R S U) | All Other Contra | $2,838 |
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