CT abdomen and pelvis with contrast at Fort HealthCare. CPT 74177.
What Fort HealthCare publishes for this service, straight from its standard-charges file, last updated June 17, 2026.
Outpatient / ER
$1,140cash price (self-pay)
$4,060list price
$85.42–$3,816range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem | Managed Medicaid | $138 |
| Dean Health Plan | Managed Medicaid | $138 |
| Quartz | Managed Medicaid | $138 |
| United Healthcare | Managed Medicaid | $141 |
| Managed Health Services | Managed Medicaid | $151 |
| Molina | Managed Medicaid | $300 |
| Humana | All Products | $315 |
| Anthem | Medicare Advantage | $344 |
| Dean Health Plan | Medicare Advantage | $344 |
| Humana | Medicare Advantage | $344 |
| Molina | Medicare Advantage | $344 |
| Quartz | Medicare Advantage | $344 |
| United Healthcare | Medicare Advantage | $344 |
| United Healthcare | Americhoice Medicare | $344 |
| United Healthcare | All Products Facility | $350 |
| United Healthcare | VACCN | $356 |
| Group Health Cooperative | Badgercare | $374 |
| Veteran Evaluation Services | All Products | $445 |
| Anthem | Blue Priority WI | $860 |
| Anthem | All Products | $955 |
| Fort Care | All Products | $967 |
| Centivo | Intermediate | $1,008 |
| Centivo | Broad | $1,050 |
| Aetna | Medicare Advantage | $1,620 |
| Dean Health Plan | All Products | $2,467 |
| Group Health Cooperative | All Products | $2,598 |
| Alliance | All Products | $2,883 |
| MercyCare | All Products | $2,991 |
| Aetna | All Products | $3,013 |
| Quartz | All Products | $3,033 |
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