CT abdomen and pelvis with contrast at Gundersen Moundview Hospital and Clinics. CPT 74177.
What Gundersen Moundview Hospital and Clinics publishes for this service, straight from its standard-charges file, last updated June 27, 2026.
Outpatient / ER
$2,033cash price (self-pay)
$4,001list price
$144–$4,968range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Amerigroup | Medicaid HMO | $144 |
| Anthem | Medicaid | $907 |
| Group Health Eau Claire | Medicaid HMO | $907 |
| Group Health of South Central | Medicaid HMO | $907 |
| Iowa Total Care | Medicaid | $907 |
| Managed Health Service | Managed Medicaid | $907 |
| Quartz | Medicaid_Badgercare | $907 |
| Alliance | Premier/All Products | $1,426 |
| Alliance | Comprehensive/All Products | $1,426 |
| Quartz | All Products | $1,692 |
| Quartz | All Other Self Funded | $1,760 |
| Security Health Plan | Medicare Advantage | $1,840 |
| Anthem | Medicare HMO/PPO | $1,840 |
| Health Partners | Medicare Advantage | $1,840 |
| Quartz | Medicare Advantage | $1,840 |
| Security Health Plan | Medicare + Choice | $1,840 |
| UCARE | Dually Eligible | $1,840 |
| Quartz | Self Funded | $1,880 |
| UCARE | MSHO/Minnesota Special Needs | $1,920 |
| UCARE | Non-Dually Eligible | $1,920 |
| Quartz | Level Funded | $1,940 |
| Dean Health Plan | ASO | $1,948 |
| Health Partners | Medicaid HMO | $2,001 |
| Quartz | Fully Insured | $2,181 |
| Health Partners | Medicare Cost | $2,401 |
| Cigna | All Products | $3,085 |
| Group Health of South Central | All Products | $3,201 |
| Trilogy | All Products | $3,201 |
| UCARE | Qualified Health Plan | $3,201 |
| Aspirus Arise Health | All Products | $3,321 |
Inpatient
$2,033cash price (self-pay)
$4,001list price
$1,692–$3,881range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Quartz | All Other Self Funded | $2,357 |
Billed more than this?
Scan my billSnap a photo of your bill. We compare every line with these prices and coding rules, free.
All common services at Gundersen Moundview Hospital and Clinics