CT abdomen and pelvis with contrast at Bellin Memorial Hospital. CPT 74177.
What Bellin Memorial Hospital publishes for this service, straight from its standard-charges file, last updated June 27, 2026.
Outpatient / ER
$737cash price (self-pay)
$2,705list price
$137–$3,436range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Chorus Community Health Plan | Managed Medicaid | $137 |
| Anthem | Managed Medicaid | $138 |
| COMMUNITY CARE | Managed Medicaid | $138 |
| ICARE | Managed Medicaid | $138 |
| Managed Health Service | Managed Medicaid | $138 |
| My Choice | SSI Managed Medicaid | $138 |
| Molina Health | Managed Medicaid | $142 |
| My Choice | BadgerChoice Plus Managed Medicaid | $145 |
| Healthpartners | Select | $175 |
| AETNA | Medicare | $339 |
| ANTHEM | Managed Medicare | $339 |
| COMMUNITY CARE | Medicare Advantage | $339 |
| HUMANA | Medicare Advantage | $339 |
| ICARE | Managed Medicare | $339 |
| Managed Health Service | Medicare Advantage | $339 |
| My Choice | Medicare Advantage | $339 |
| Network Health | Medicare Advantage | $339 |
| Security Health Plan | Medicare Advantage | $339 |
| Healthpartners | Focus | $345 |
| Healthpartners | Broad | $373 |
| Anthem | Priority | $1,037 |
| Anthem | HMO/POS | $1,127 |
| United Health Care | HMO | $1,225 |
| Aspirus Arise | ALL PRODUCTS | $1,289 |
| Anthem | PPO | $1,365 |
| WPS Insurance | BROAD | $1,410 |
| Network Health | ALL PRODUCTS | $1,693 |
| Chorus Community Health Plan | ALL PRODUCTS | $1,739 |
| Cigna Health and Life Insurance Company | ALL PRODUCTS | $1,888 |
| HPS/Paymedix | Medical Rental Network Tier 1 | $1,947 |
Inpatient
$737cash price (self-pay)
$2,705list price
$1,023–$3,436range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Cigna Health and Life Insurance Company | ALL PRODUCTS | $1,909 |
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