CT abdomen and pelvis with contrast at Froedtert West Bend Hospital. CPT 74177.
What Froedtert West Bend Hospital publishes for this service, straight from its standard-charges file, last updated December 31, 2025.
Outpatient / ER
$2,819cash price (self-pay)
$5,125list price
$347–$4,869range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Allwell | Medicare Advantage | $347 |
| Anthem Blue Cross Blue Shield | 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 |
| Aetna | Medicare Advantage | $354 |
| Care Wisconsin | Medicare Advantage | $357 |
| Network Health Plan | ACA | $930 |
| Network Health Plan | All Contracted Commercial Payers | $1,033 |
| United Healthcare | Nexus | $1,112 |
| United Healthcare | Choice Plus/Navigate | $1,306 |
| Anthem Blue Cross Blue Shield | HMO | $1,379 |
| Centivo | WI 2 Median | $1,538 |
| United Healthcare | Options PPO | $1,565 |
| Centivo | WI 1 Broad | $1,691 |
| UMR | MCW Employees | $1,691 |
| Sheboygan Employers Health Network | All Contracted Commercial Payers | $1,791 |
| Froedtert South | All Contracted Commercial Plans | $2,153 |
| Chorus Community Health Plan | All Contracted Commercial Plans | $2,204 |
| Common Ground | All Contracted Commercial Plans | $3,075 |
| Health Payment Systems | Group Specific | $3,228 |
| Health Partners | All Contracted Commercial Plans | $3,331 |
| Aetna | All Contracted Commercial Plans | $3,588 |
| Wisconsin Physician Services | All Contracted Commercial Plans | $4,100 |
| Health Payment Systems | Other Commercial Plans | $4,143 |
Inpatient
$2,819cash price (self-pay)
$5,125list price
$3,075–$4,869range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Common Ground | All Contracted Commercial Plans | $3,075 |
| Health Payment Systems | Group Specific | $3,228 |
| Aetna | All Contracted Commercial Plans | $3,588 |
| Health Payment Systems | Other Commercial Plans | $4,143 |
| Trilogy | All Contracted Commercial Plans | $4,203 |
| Americas Choice | PPO | $4,459 |
| HealthEos | All Contracted Commercial Plans | $4,459 |
| Multiplan/Private Healthcare Systems | All Contracted Commercial Plans | $4,459 |
| First Health Network | All Contracted Commercial Plans | $4,510 |
| Hfn | PPO | $4,613 |
| IBSI Passport | All Contracted Commercial Plans | $4,613 |
| Cigna | All Contracted Commercial Plans | $4,869 |
| HealthSmart | All Contracted Commercial Plans | $4,869 |
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