CT abdomen and pelvis with contrast at Santa Rosa Medical Center. CPT 74177.
What Santa Rosa Medical Center publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$2,372cash price (self-pay)
$15,817list price
$207–$12,653range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Amerigroup Medicaid | Amerigroup Medicaid FL | $226 |
| FL Community Care | FL Community Care | $238 |
| Veterans Eval Services | Veterans Eval Services | $336 |
| NODE Humana MCR PPO PFFS | NODE Humana MCR PPO PFFS | $341 |
| Prime Health Work Comp FL | Prime Health Work Comp FL | $341 |
| NODE Tricare | NODE Tricare | $346 |
| Florida Workers Compensation | FL Work Comp | $352 |
| NODE Aetna MCR ADV | NODE Aetna MCR ADV | $358 |
| Node BCBS FL Mcr Adv | Node BCBS FL Mcr Adv | $358 |
| NODE Cigna Healthspring MCR ADV | NODE Cigna Healthspring MCR ADV | $358 |
| NODE Humana MCR HMO POS | NODE Humana MCR HMO POS | $358 |
| NODE Medicare Non Par | NODE Medicare Non Par | $358 |
| NODE Medicare Traditional | NODE Medicare Traditional | $358 |
| Node UHC Mcr Adv | Node UHC Mcr Adv | $358 |
| NODE ChampVA | NODE ChampVA | $364 |
| Hospice of NW FL | Hospice of NW FL | $364 |
| NODE United Optum VA CCN | NODE United Optum VA CCN | $364 |
| Node Va | Node Va | $364 |
| NODE Wellcare MCR ADV | NODE Wellcare MCR ADV | $376 |
| GEO Group | GEO Group | $455 |
| NODE US Dept of Labor | NODE US Dept of Labor | $455 |
| Oscar | Oscar | $676 |
| Florida State Auto Insurance | State Auto Insurance FL | $729 |
| SUNSHINE HEALTH AMBETTER MARKETPLACE | Sunshine State Health Plan Comm | $871 |
| United Healthcare | UHC APA | $1,200 |
| Blue Cross and Blue Shield of Florida | BCBS FL BSL | $1,313 |
| Blue Cross and Blue Shield of Florida | BCBS FL MBN | $1,313 |
| Blue Cross and Blue Shield of Florida | BCBS FL HMO | $1,386 |
| BCBS FL Sbn | BCBS FL Sbn | $1,386 |
| Aetna Health | Aetna NAB/First Health | $1,469 |
Inpatient
$5,536cash price (self-pay)
$15,817list price
$3,068–$12,653range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| CHS Group Health Plan UMR | CHS Group Health Plan UMR | $3,068 |
| Cigna | Cigna ALL | $3,575 |
| Self Pay | Self Pay | $3,638 |
| Aetna Health | Aetna INTL Passport | $8,873 |
| Prime Health Services | Prime Health | $12,653 |
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