CT abdomen and pelvis with contrast at Ogallala Community Hospital. CPT 74177.
What Ogallala Community Hospital publishes for this service, straight from its standard-charges file, last updated February 12, 2026.
Outpatient / ER
$1,694cash price (self-pay)
$2,655list price
$1,168–$2,575range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Banner Health | Banner Choice Plus/Banner Select | $1,168 |
| Blue Cross Blue Shield of Wyoming | Medicare Advantage | $1,168 |
| Medica | Medicare Advantage | $1,168 |
| TriWest Healthcare Alliance Corp - VA CCN | Tricare | $1,168 |
| United Healthcare | UHC Medicare Advantage | $1,221 |
| United Healthcare | VA Community Care | $1,221 |
| Molina Healthcare | Medicaid/CHIP | $1,301 |
| Nebraska Total Care | Medicaid | $1,301 |
| United Healthcare | Nebraska Medicaid/CHIP | $1,301 |
| Keith County Sheriff’s Office | Imate/Detainee Plan | $1,991 |
| Apostrophe, Inc. | Commercial | $2,390 |
| Blue Cross Blue Shield of Wyoming | Network Blue | $2,515 |
| United Healthcare | Commercial/Individual Exchange | $2,522 |
| Medica | Commercial | $2,530 |
| First Health | Medical Rental | $2,549 |
| Coventry | Commercial | $2,549 |
| Coventry | Workers Comp | $2,549 |
| Midlands Choice | Commercial | $2,549 |
| Multiplan | Commercial | $2,575 |
Inpatient
$1,694cash price (self-pay)
$2,655list price
$1,991–$2,575range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Keith County Sheriff’s Office | Imate/Detainee Plan | $1,991 |
| Apostrophe, Inc. | Commercial | $2,390 |
| United Healthcare | Commercial/Individual Exchange | $2,522 |
| First Health | Medical Rental | $2,549 |
| Blue Cross Blue Shield of Wyoming | Network Blue | $2,549 |
| Coventry | Commercial | $2,549 |
| Coventry | Workers Comp | $2,549 |
| Midlands Choice | Commercial | $2,549 |
| Multiplan | Commercial | $2,575 |
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