CT abdomen and pelvis with contrast at SSM Health St. Clare Hospital - Baraboo. CPT 74177.
What SSM Health St. Clare Hospital - Baraboo publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$2,884cash price (self-pay)
$5,243list price
$254–$2,541range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Molina | Medicare Managed Care Plan | $254 |
| Dean Health Plan | Medicare Managed Care Plan | $339 |
| BCBS | Blue Preferred/Blue Preferred Plus HMO/POS | $2,368 |
| BCBS | Blue Access PPO | $2,541 |
| BCBS | Blue Traditional Traditional | $2,541 |
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All common services at SSM Health St. Clare Hospital - Baraboo