CT abdomen and pelvis with contrast at Jackson West Medical Center. CPT 74177.
What Jackson West Medical Center publishes for this service, straight from its standard-charges file, last updated September 23, 2026.
Outpatient / ER
$392cash price (self-pay)
$5,999list price
$204–$10,192range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna Better Hlth Mcaid | Aetna Better Hlth Mcaid | $204 |
| Comm Care Mcaid - All Other Plans | Comm Care Mcaid - All Other Plans | $204 |
| Humana Mcaid | Humana Mcaid | $204 |
| Simply Hlth Mcaid - All Other Plans | Simply Hlth Mcaid - All Other Pl | $204 |
| Sunshine Mcaid - All Other Plans | Sunshine Mcaid - All Other Plans | $204 |
| Molina Kidcare | Molina Kidcare | $214 |
| Molina Mcaid | Molina Mcaid | $214 |
| Pace Mcaid - All Other Plans | Pace Mcaid - All Other Plans | $265 |
| Tricare - All Plans | Tricare - All Plans | $291 |
| Healthsun Mcr Adv - All Plans | Healthsun Mcr Adv - All Plans | $317 |
| Simply Hlth Mcr | Simply Hlth Mcr | $317 |
| Leon Hlth Mcr - All Plans | Leon Hlth Mcr - All Plans | $328 |
| Pace Mcr Adv | Pace Mcr Adv | $328 |
| Doctors Hlthcare Mcr Adv - All Plans | Doctors Hlthcare Mcr Adv - All | $364 |
| Preferred Care - All Plans | Preferred Care - All Plans | $364 |
| UHC Mcr Adv | UHC Mcr Adv | $364 |
| Ambetter Exch - All Plans | Ambetter Exch - All Plans | $401 |
| Molina Mcare | Molina Mcare | $401 |
| Align Mcr Adv - All Plans | Align Mcr Adv - All Plans | $408 |
| Gold Kidney - All Plans | Gold Kidney - All Plans | $408 |
| Avmed Exch | Avmed Exch | $506 |
| Amerihealth Exch - All Other Plans | Amerihealth Exch - All Other Plan | $510 |
| Cigna Surefit Ifp | Cigna Surefit Ifp | $593 |
| Avmed Comm - All Other Plans | Avmed Comm - All Other Plans | $649 |
| UHC All Payer - All Other Plans | UHC All Payer - All Other Plans | $663 |
| UHC Indiv Exch | UHC Indiv Exch | $663 |
| UHC Options PPO | UHC Options PPO | $663 |
| Claimdoc - All Plans | Claimdoc - All Plans | $710 |
| BCBS FL Blue HMO | BCBS FL Blue HMO | $1,013 |
| Aetna Exchange | Aetna Exchange | $1,071 |
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