CT abdomen and pelvis with contrast at CHI Health Plainview. CPT 74177.

What CHI Health Plainview publishes for this service, straight from its standard-charges file, last updated February 28, 2026.

Outpatient / ER

$5,878cash price (self-pay)

$6,998list price

$2,650–$9,477range insurers pay

Insurance plan	Negotiated rate
BCBS - NE \| Commercial\|BluePrint	$2,650
BCBS - NE \| Commercial\|All Other Plans	$2,789
BCBS - NE \| Medicare\|All Plans	$4,269
Humana \| Medicare\|All Plans	$4,269
Medica \| Medicare\|All Plans	$4,269
PACE \| Medicare\|All Plans	$4,269
United \| Medicare\|All Plans	$4,269
Centene \| Medicare\|All Plans	$4,354
Todays Options \| Medicare\|All Plans	$4,354
Amerigroup \| Medicare\|All Plans	$4,482
Great Plains \| Medicare\|All Plans	$4,482
Centene \| Medicaid\|NE Total Care	$4,549
United \| Medicaid\|Community Plan	$4,549
IAMolina \| Medicaid\|All Plans	$4,731
Medica \| Commercial\|All Other Plans	$6,368
Medica \| Commercial\|CHI Health	$6,368
United \| Commercial\|All Plans	$6,648
Greater Omaha Packing \| Commercial\|Broad Network	$6,718
Greater Omaha Packing \| Commercial\|Narrow Network	$6,718
Medica \| Commercial\|ACO	$6,718
Medica \| Commercial\|Open Access	$6,718
Midlands Choice \| Commercial\|Premier	$6,718
Midlands Choice \| Commercial\|Standard	$6,718
Millard Public Schools \| Commercial\|Broad Network	$6,718
Millard Public Schools \| Commercial\|Narrow Network	$6,718
One World \| Commercial\|Broad Network	$6,718
One World \| Commercial\|Narrow Network	$6,718
QuikTrip \| Commercial\|All Plans	$6,718
Timpte \| Commercial\|Broad Network	$6,718
MultiPlan \| Commercial\|All Plans	$6,858

$5,878cash price (self-pay)

$6,998list price

$6,316–$6,858range insurers pay

Insurance plan	Negotiated rate
BCBS - NE \| Commercial\|BluePrint	$6,316
Medica \| Commercial\|All Other Plans	$6,368
Medica \| Commercial\|CHI Health	$6,368
BCBS - NE \| Commercial\|All Other Plans	$6,648
United \| Commercial\|All Plans	$6,648
Greater Omaha Packing \| Commercial\|Broad Network	$6,718
Greater Omaha Packing \| Commercial\|Narrow Network	$6,718
Medica \| Commercial\|ACO	$6,718
Medica \| Commercial\|Open Access	$6,718
Midlands Choice \| Commercial\|Premier	$6,718
Midlands Choice \| Commercial\|Standard	$6,718
Millard Public Schools \| Commercial\|Broad Network	$6,718
Millard Public Schools \| Commercial\|Narrow Network	$6,718
One World \| Commercial\|Broad Network	$6,718
One World \| Commercial\|Narrow Network	$6,718
QuikTrip \| Commercial\|All Plans	$6,718
Timpte \| Commercial\|Broad Network	$6,718
MultiPlan \| Commercial\|All Plans	$6,858
PHCS \| Commercial\|All Plans	$6,858

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