CT abdomen and pelvis with contrast at Froedtert Community Hospital - Pewaukee. CPT 74177.
What Froedtert Community Hospital - Pewaukee publishes for this service, straight from its standard-charges file, last updated December 31, 2025.
Outpatient / ER
$2,396cash price (self-pay)
$4,357list price
$347–$3,834range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem Blue Cross Blue Shield | Medicare Advantage | $347 |
| Care Wisconsin | Medicare Advantage | $347 |
| Community Care | Medicare Advantage | $347 |
| Health Partners | Medicare Advantage | $347 |
| Humana | Medicare Advantage | $347 |
| ICare | Medicare Advantage | $347 |
| Molina | Medicare Advantage | $347 |
| Network Health Plan | Medicare Advantage | $347 |
| Security Health Plan Secure Savers | Medicare Advantage | $347 |
| United Healthcare | Medicare Advantage | $347 |
| Network Health Plan | ACA | $745 |
| United Healthcare | Nexus | $811 |
| Network Health Plan | All Contracted Commercial Payers | $827 |
| United Healthcare | Choice Plus/Navigate | $954 |
| Anthem Blue Cross Blue Shield | Blue Preferred/HMO/POS | $1,048 |
| United Healthcare | Options PPO | $1,136 |
| Anthem Blue Cross Blue Shield (Healthlink) | Federal/Out of State/PPO | $1,362 |
| Chorus Community Health Plan | All Contracted Commercial Plans | $1,743 |
| Medical College of Wisconsin | Employee Plan | $1,743 |
| Centivo | WI 2 Median | $1,873 |
| Centivo | WI 1 Broad | $2,178 |
| Cigna | All Contracted Commercial Plans | $2,557 |
| Common Ground | All Contracted Commercial Plans | $2,614 |
| Sheboygan Employers Health Network | All Contracted Commercial Payers | $2,614 |
| Wisconsin Physician Services | All Contracted Commercial Plans | $2,614 |
| Health Payment Systems | All Contracted Commercial Plans | $2,662 |
| Health Partners | All Contracted Commercial Payers | $2,832 |
| Trilogy | All Contracted Commercial Plans | $2,832 |
| Americas Choice | PPO | $3,790 |
| HealthEos | All Contracted Commercial Plans | $3,790 |
Inpatient
$2,396cash price (self-pay)
$4,357list price
$2,614–$3,834range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Common Ground | All Contracted Commercial Plans | $2,614 |
| Health Payment Systems | All Contracted Commercial Plans | $2,662 |
| Trilogy | All Contracted Commercial Plans | $2,832 |
| Americas Choice | PPO | $3,790 |
| HealthEos | All Contracted Commercial Plans | $3,790 |
| Multiplan/Private Healthcare Systems | All Contracted Commercial Plans | $3,790 |
| First Health Network | All Contracted Commercial Plans | $3,834 |
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All common services at Froedtert Community Hospital - Pewaukee