CT abdomen and pelvis with contrast at Emplify Health Behavioral Health. CPT 74177.
What Emplify Health Behavioral Health publishes for this service, straight from its standard-charges file, last updated June 27, 2026.
Outpatient / ER
$737cash price (self-pay)
$1,591list price
$175–$1,432range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Healthpartners | Select | $175 |
| Anthem | Managed Medicaid | $292 |
| COMMUNITY CARE | Managed Medicaid | $292 |
| ICARE | Managed Medicaid | $292 |
| Managed Health Service | Managed Medicaid | $292 |
| My Choice | SSI Managed Medicaid | $292 |
| Trilogy | Managed Medicaid | $292 |
| United Behavioral Health | Managed Medicaid | $292 |
| Molina Health | Managed Medicaid | $300 |
| Chorus Community Health Plan | Managed Medicaid | $303 |
| My Choice | BadgerChoice Plus Managed Medicaid | $306 |
| Healthpartners | Focus | $345 |
| ANTHEM | Managed Medicare | $356 |
| Healthpartners | Broad | $373 |
| AETNA | Medicare | $410 |
| COMMUNITY CARE | Medicare Advantage | $410 |
| HUMANA | Medicare Advantage | $410 |
| ICARE | Managed Medicare | $410 |
| Managed Health Service | Medicare Advantage | $410 |
| My Choice | Medicare Advantage | $410 |
| Network Health | Medicare Advantage | $410 |
| Security Health Plan | Medicare Advantage | $410 |
| Anthem | Priority | $955 |
| WPS Insurance | BROAD | $998 |
| Chorus Community Health Plan | ALL PRODUCTS | $1,023 |
| Anthem | HMO/POS | $1,066 |
| Anthem | PPO | $1,066 |
| Aspirus Arise | ALL PRODUCTS | $1,067 |
| Network Health | ALL PRODUCTS | $1,146 |
| HPS/Paymedix | Medical Rental Network Tier 1 | $1,193 |
Inpatient
$737cash price (self-pay)
$1,591list price
$410–$1,432range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| COMMUNITY CARE | Medicare Advantage | $894 |
| HUMANA | Medicare Advantage | $894 |
| Managed Health Service | Medicare Advantage | $894 |
| Network Health | Medicare Advantage | $894 |
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