CT abdomen and pelvis with contrast at Providence Medical Center. CPT 74177.
What Providence Medical Center publishes for this service, straight from its standard-charges file, last updated October 29, 2025.
Outpatient / ER
$4,656cash price (self-pay)
$4,901list price
$2,859–$4,803range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Cross Blue Shield | Commercial | $2,859 |
| Molina Health (Healthy Blue) | Managed Medicaid | $2,892 |
| Nebraska Total Care | Managed Medicaid | $2,892 |
| United Healthcare Community Plan | Managed Medicaid | $2,892 |
| Medica | Commercial | $4,411 |
| Aetna | Commercial | $4,509 |
| Ambetter | Commercial | $4,705 |
| Multiplan | Commercial | $4,705 |
| Midland's Choice | Commercial | $4,803 |
| United Healthcare | Commercial | $4,803 |
Inpatient
$4,656cash price (self-pay)
$4,901list price
$4,411–$4,803range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medica | Commercial | $4,411 |
| Aetna | Commercial | $4,509 |
| Ambetter | Commercial | $4,705 |
| Multiplan | Commercial | $4,705 |
| Midland's Choice | Commercial | $4,803 |
| United Healthcare | Commercial | $4,803 |
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