CT abdomen and pelvis with contrast at Jefferson Community Health Center. CPT 74177.
What Jefferson Community Health Center publishes for this service, straight from its standard-charges file, last updated July 9, 2026.
Outpatient / ER
—cash price (self-pay)
$4,962list price
$2,481–$4,764range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Nebraska Total Care | Medicaid MCO | $2,481 |
| United Healthcare Medicaid | Medicaid MCO | $2,481 |
| Molina | Medicaid MCO | $2,481 |
| Blue Cross HIX | Health Exchange | $2,716 |
| Blue Cross HMO/PPO | HMO/PPO | $2,859 |
| Aetna Medicare Advantage | Medicare Advantage | $2,928 |
| United Healthcare Medicare Advantage | Medicare Advantage | $2,928 |
| Blue Cross Medicare Advantage | Medicare Advantage | $2,928 |
| United Healthcare HMO/PPO | HMO/PPO | $4,714 |
| Aetna HMO/PPO | HMO/PPO | $4,764 |
| Midlands Choice | HMO/PPO | $4,764 |
Inpatient
—cash price (self-pay)
$4,962list price
$4,478–$4,764range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Cross HIX | Health Exchange | $4,478 |
| Blue Cross HMO/PPO | HMO/PPO | $4,714 |
| United Healthcare HMO/PPO | HMO/PPO | $4,714 |
| Aetna HMO/PPO | HMO/PPO | $4,764 |
| Midlands Choice | HMO/PPO | $4,764 |
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