CT abdomen and pelvis with contrast at Franklin Country Memorial Hospital. CPT 74177.
What Franklin Country Memorial Hospital publishes for this service, straight from its standard-charges file.
Outpatient / ER
$4,405cash price (self-pay)
$4,894list price
$711–$4,649range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Midlands Choice | PPO | $711 |
| Blue Cross Blue Shield of Nebraska | PPO | $2,859 |
| Blue Cross Blue Shield of Nebraska | Commercial | $2,859 |
| United Healthcare | PPO | $4,045 |
| United Healthcare | Commercial | $4,045 |
| United Healthcare | HMO | $4,045 |
| Aetna | Medicare Advantage | $4,258 |
| Aetna | Commercial | $4,649 |
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