CT abdomen and pelvis with contrast at Gundersen TriCounty Hospital and Clinics. CPT 74177.
What Gundersen TriCounty Hospital and Clinics publishes for this service, straight from its standard-charges file, last updated June 27, 2026.
Outpatient / ER
$1,739cash price (self-pay)
$2,743list price
$144–$4,968range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Amerigroup | Medicaid HMO | $144 |
| Anthem | Medicaid | $709 |
| Group Health Eau Claire | Medicaid HMO | $709 |
| Group Health of South Central | Medicaid HMO | $709 |
| Iowa Total Care | Medicaid | $709 |
| Managed Health Service | Managed Medicaid | $709 |
| Quartz | Medicaid_Badgercare | $709 |
| Quartz | All Products | $1,160 |
| Quartz | All Other Self Funded | $1,207 |
| Quartz | Self Funded | $1,289 |
| Quartz | Level Funded | $1,330 |
| UCARE | Non-Dually Eligible | $1,426 |
| UCARE | MSHO/Minnesota Special Needs | $1,426 |
| UCARE | Dually Eligible | $1,426 |
| Quartz | Fully Insured | $1,495 |
| Anthem | Medicare HMO/PPO | $1,618 |
| Humana | Medicare Advantage | $1,618 |
| Quartz | Medicare Advantage | $1,618 |
| UHC | Medicare Advantage | $1,618 |
| UHC | All Payer Appendix | $1,975 |
| Cigna | All Products | $2,115 |
| Alliance | Premier/All Products | $2,194 |
| Group Health of South Central | All Products | $2,194 |
| Trilogy | All Products | $2,194 |
| UCARE | Qualified Health Plan | $2,194 |
| Anthem | HMO/POS | $2,202 |
| Aspirus Arise Health | All Products | $2,277 |
| Allied National | Core Value Programs | $2,332 |
| Sana | All Products | $2,359 |
| Group Health Eau Claire | All Products | $2,469 |
Inpatient
$1,739cash price (self-pay)
$2,743list price
$1,160–$2,606range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Quartz | All Other Self Funded | $1,616 |
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All common services at Gundersen TriCounty Hospital and Clinics