CT abdomen and pelvis with contrast at Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.). CPT 74177.
What Ascension Columbia St. Mary's Hospital - Ozaukee Campus (Columbia St. Mary's Hospital Milwaukee, Inc.) publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$1,898cash price (self-pay)
$3,582list price
$143–$1,007range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medicare Replacement | 1109_medicare Replacement Outpatient 20220701 | $348 |
| Veterans Administration | 1064_veterans Administration Outpatient 2022 | $348 |
| Network Health Plan | 1136_network Health Plan 20221001 | $379 |
| Humana HMO POS | 1127_humana 20221001 | $613 |
| UHC Non Options PPO | 1130_united Health Care Nonoptions 20221001 | $613 |
| Humana PPO | 1133_humana PPO 20221001 | $613 |
| Humana Preferred | 1134_humana Preferred 20221001 | $613 |
| Alliance | 1066_alliance 20220101 | $703 |
| Molina Health Marketplace | 1060_molina Marketplace Outpatient 2022010 | $765 |
| Cchp Marketplace | 1124_cchp Marketplace 20221001 | $828 |
Inpatient
—cash price (self-pay)
—list price
$348–$765range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medicare Replacement | 1116_medicare Replacement Inpatient 20221001 | $348 |
| Veterans Administration | 1114_veterans Administration Inpatient 20221 | $348 |
| Molina Health Marketplace | 1111_molina Marketplace Inpatient 20221001 | $765 |
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