CT abdomen and pelvis with contrast at Gundersen St. Josephs Hospital and Clinic. CPT 74177.
What Gundersen St. Josephs Hospital and Clinic publishes for this service, straight from its standard-charges file, last updated June 27, 2026.
Outpatient / ER
$2,091cash price (self-pay)
$3,975list price
$144–$4,968range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Amerigroup | Medicaid HMO | $144 |
| Anthem | Medicaid | $826 |
| Dean Health Plan | Medicaid_Badgercare | $826 |
| Group Health Eau Claire | Medicaid HMO | $826 |
| Group Health of South Central | Medicaid HMO | $826 |
| Iowa Total Care | Medicaid | $826 |
| Quartz | Medicaid_Badgercare | $826 |
| Managed Health Service | Managed Medicaid | $907 |
| Quartz | All Products | $1,681 |
| Quartz | All Other Self Funded | $1,749 |
| Dean Health Plan | All Products | $1,759 |
| Quartz | Self Funded | $1,868 |
| Quartz | Level Funded | $1,928 |
| Anthem | Medicare HMO/PPO | $2,027 |
| Dean Health Plan | Medicare Select | $2,027 |
| Humana | Medicare Advantage | $2,027 |
| Quartz | Medicare Advantage | $2,027 |
| UCARE | Dually Eligible | $2,027 |
| UHC | Medicare Advantage | $2,027 |
| UCARE | Non-Dually Eligible | $2,067 |
| UCARE | MSHO/Minnesota Special Needs | $2,067 |
| Quartz | Fully Insured | $2,166 |
| UHC | All Payer Appendix | $2,779 |
| Cigna | All Products | $3,065 |
| Alliance | Premier/All Products | $3,180 |
| Group Health of South Central | All Products | $3,180 |
| Trilogy | All Products | $3,180 |
| UCARE | Qualified Health Plan | $3,180 |
| Aspirus Arise Health | All Products | $3,299 |
| Allied National | Core Value Programs | $3,379 |
Inpatient
$2,091cash price (self-pay)
$3,975list price
$1,681–$3,776range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Quartz | All Other Self Funded | $2,341 |
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All common services at Gundersen St. Josephs Hospital and Clinic