CT abdomen and pelvis with contrast at Ascension NE Wisconsin - Mercy Campus (Ascension NE Wisconsin, Inc.). CPT 74177.
What Ascension NE Wisconsin - Mercy Campus (Ascension NE Wisconsin, Inc.) publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$808cash price (self-pay)
$1,418list price
$91.80–$818range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem Blue Connection | 999_anthem Blue Connection Mewi Sewi 20230401 | $91.80 |
| Anthem HMO POS | 1000_anthem HMO POS Mewi Sewi 20230401 | $91.80 |
| Anthem Pathways | 946_anthem Pathways Mewi Sewi 20230101 | $91.80 |
| Anthem PPO | 1001_anthem PPO Mewi Sewi 20230401 | $91.80 |
| Medicare Replacement | 914_medicare Replacement Outpatient Mewi Sewi 2 | $343 |
| Veterans Administration | 916_veterans Administration Outpatient Mewi | $343 |
| Wellcare | 973_medicare Advantage Wellcare Outpatient 20230101 | $361 |
| Smarthealth | 964_smarthealth Outpatient 20230101 | $481 |
| Centivo Nw1 | 892_centivo Nw1 Mewi Sewi 20221001 | $561 |
| Centivo Nw3 | 1013_centivo Nw3 Mewi Sewi 20221001 | $561 |
| Cchp | 931_cchp Mewi Sewi 20230101 | $611 |
| Molina Marketplace | 911_molina Marketplace Outpatient Mewi Sewi 20230 | $721 |
Inpatient
—cash price (self-pay)
—list price
$343–$721range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medicare Replacement | 959_medicare Replacement Inpatient Mewi Sewi 20 | $343 |
| Veterans Administration | 956_veterans Administration Inpatient Mewi S | $343 |
| Wellcare | 970_medicare Advantage Wellcare Inpatient 20230512 | $361 |
| Smarthealth | 963_smarthealth Inpatient 20231001 | $481 |
| Molina Marketplace | 954_molina Marketplace Inpatient Mewi Sewi 202305 | $721 |
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All common services at Ascension NE Wisconsin - Mercy Campus (Ascension NE Wisconsin, Inc.)