CT abdomen and pelvis with contrast at CHI Health St. Mary's. CPT 74177.
What CHI Health St. Mary's publishes for this service, straight from its standard-charges file, last updated February 28, 2026.
Outpatient / ER
$5,104cash price (self-pay)
$6,149list price
$1,317–$5,903range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Amerigroup | Medicaid|All Plans | $1,317 |
| IAMolina | Medicaid|All Plans | $1,343 |
| BCBS - NE | Medicare|All Plans | $2,460 |
| Humana | Medicare|All Plans | $2,460 |
| Medica | Medicare|All Plans | $2,460 |
| PACE | Medicare|All Plans | $2,460 |
| United | Medicare|All Plans | $2,460 |
| Centene | Medicare|All Plans | $2,509 |
| Centene | Medicaid|NE Total Care | $2,521 |
| United | Medicaid|Community Plan | $2,521 |
| Amerigroup | Medicare|All Plans | $2,583 |
| Great Plains | Medicare|All Plans | $2,583 |
| BCBS - NE | Commercial|BluePrint | $2,650 |
| BCBS - NE | Commercial|All Other Plans | $2,789 |
| AMPS | Commercial|All Plans | $5,460 |
| Medica | Commercial|All Other Plans | $5,596 |
| Medica | Commercial|CHI Health | $5,596 |
| MultiPlan PHCS | Commercial|All Plans | $5,842 |
| Greater Omaha Packing | Commercial|Broad Network | $5,903 |
| Greater Omaha Packing | Commercial|Narrow Network | $5,903 |
| Medica | Commercial|ACO | $5,903 |
| Medica | Commercial|Open Access | $5,903 |
| Midlands Choice | Commercial|Premier | $5,903 |
| Midlands Choice | Commercial|Standard | $5,903 |
| Millard Public Schools | Commercial|Broad Network | $5,903 |
| Millard Public Schools | Commercial|Narrow Network | $5,903 |
| One World | Commercial|Broad Network | $5,903 |
| One World | Commercial|Narrow Network | $5,903 |
| Timpte | Commercial|Broad Network | $5,903 |
| United | Commercial|All Plans | $5,903 |
Inpatient
$5,104cash price (self-pay)
$6,149list price
$5,549–$5,903range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| BCBS - NE | Commercial|BluePrint | $5,549 |
| Medica | Commercial|All Other Plans | $5,596 |
| Medica | Commercial|CHI Health | $5,596 |
| BCBS - NE | Commercial|All Other Plans | $5,842 |
| MultiPlan PHCS | Commercial|All Plans | $5,842 |
| Greater Omaha Packing | Commercial|Broad Network | $5,903 |
| Greater Omaha Packing | Commercial|Narrow Network | $5,903 |
| Medica | Commercial|ACO | $5,903 |
| Medica | Commercial|Open Access | $5,903 |
| Midlands Choice | Commercial|Premier | $5,903 |
| Midlands Choice | Commercial|Standard | $5,903 |
| Millard Public Schools | Commercial|Broad Network | $5,903 |
| Millard Public Schools | Commercial|Narrow Network | $5,903 |
| One World | Commercial|Broad Network | $5,903 |
| One World | Commercial|Narrow Network | $5,903 |
| Timpte | Commercial|Broad Network | $5,903 |
| United | Commercial|All Plans | $5,903 |
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