CT abdomen and pelvis with contrast at Aspirus Divine Savior Hospital. CPT 74177.
What Aspirus Divine Savior Hospital publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$584cash price (self-pay)
$4,936list price
$64.12–$2,542range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Quartz Health Solutions, Inc. | Quartz Wisconsin Medicaid Plans | $64.12 |
| Anthem Blue Cross Blue Shield Wisconsin | Anthem Mediblue Dual Hmo Snp | $64.27 |
| Anthem Blue Cross Blue Shield Wisconsin | Anthem Wisconsin Medicaid Pl | $65.40 |
| Dean Health Plan | Dean Health Plan Wisconsin Medicaid Plans | $65.40 |
| Group Health Cooperative Of Eau Claire | Group Health Wisconsin Medica | $65.40 |
| Aspirus Health Plan, Inc. | Aspirus Health Plan Medicare Advantage | $78.76 |
| Humana | Humana Medicare Ppo/Pos/Hmo Network Plans | $78.76 |
| Quartz Health Solutions, Inc. | Quartz Medicare Advantage Plans | $78.76 |
| Anthem Blue Cross Blue Shield Wisconsin | Anthem Mediblue Plus Hmo | $80.34 |
| Anthem Blue Cross Blue Shield Wisconsin | Anthem Medicare Advantage Pl | $80.34 |
| Dean Health Plan | Dean Health Plan Medicare Advantage | $80.34 |
| Tricare West | Tricare Plans | $80.37 |
| Security Health Plan Of Wisconsin, Inc. | Security Health Plan Wiscons | $81.68 |
| United Healthcare Of Wisconsin, Inc. | United Healthcare Medicare Adva | $81.98 |
| Managed Health Services Insurance Corp. | Managed Health Wisconsin Med | $82.70 |
| Multiplan, Inc | Aetna Health Plan Ppo Networks | $201 |
| Anthem Blue Cross Blue Shield Wisconsin | Anthem Mediblue Access Ppo | $213 |
| Cigna | Cigna Ppo And Open Access Plus Benefit Plans | $237 |
| Quartz Health Solutions, Inc. | Quartz Fully Insured And Self Insured | $244 |
| Wps Health Plan | Wps Statewide Ppo/Pos/Epo Plans | $421 |
| Aspirus Health Plan, Inc. | Aspirus Health Plan Hmo/Pos | $456 |
| Aetna | Medicare Advantage Esa | $490 |
| Group Health Cooperative Of South Central Wisconsin | Group Health Coo | $535 |
| United Healthcare Of Wisconsin, Inc. | United Healthcare Hmo/Ppo/Pos/E | $630 |
| Anthem Blue Cross Blue Shield Wisconsin | Anthem Blue Preferred Pos | $659 |
| Anthem Blue Cross Blue Shield Wisconsin | Anthem Blue Traditional Netw | $692 |
| Anthem Blue Cross Blue Shield Wisconsin | Anthem Federal Employee Prog | $692 |
| Group Health Cooperative Of Eau Claire | Group Health Cooperative Comm | $718 |
| Anthem Blue Cross Blue Shield Wisconsin | Anthem Blue Preferred Hmo | $794 |
| The Alliance (F/K/A Employer Health Care Alliance Cooperative) | The A | $915 |
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