CT abdomen and pelvis with contrast at Dorminy Medical Center. CPT 74177.
What Dorminy Medical Center publishes for this service, straight from its standard-charges file, last updated May 6, 2026.
Outpatient / ER
$1,416cash price (self-pay)
$2,833list price
$304–$2,691range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna Medicare Advantage | Advantage | $304 |
| Humana Medicare Advantage | Advantage | $304 |
| Anthem Blue Cross Medicare Advantage | Advantage | $304 |
| United HealthCare Medicare Advantage | Advantage | $304 |
| Anthem Blue Cross Pathway | Pathway | $387 |
| Anthem Blue Cross HMO | HMO | $483 |
| Anthem BCBS PPO | PPO | $483 |
| HealthSmart | All Commercial Plans | $2,125 |
| Aetna Commercial | PPO/HMO | $2,266 |
| Provider Network of America | All Commercial Plans | $2,408 |
| Principal Edge Network | All Commercial Plans | $2,464 |
| United HealthCare Commercial | PPO/HMO | $2,464 |
| Cigna Commercial | PPO/HMO | $2,493 |
| Humana ChoiceCare | All Commercial Plans | $2,493 |
| Novanet | All Commercial Plans | $2,549 |
| Unicare | All Commercial Plans | $2,549 |
| PHCS | All Commercial Plans | $2,549 |
| MultiPlan | PPO/HMO | $2,549 |
| Three Rivers Provider Network | All Commercial Plans | $2,691 |
Inpatient
$1,416cash price (self-pay)
$2,833list price
$2,125–$2,691range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| HealthSmart | All Commercial Plans | $2,125 |
| Aetna Commercial | PPO/HMO | $2,266 |
| Provider Network of America | All Commercial Plans | $2,408 |
| Principal Edge Network | All Commercial Plans | $2,464 |
| United HealthCare Commercial | PPO/HMO | $2,464 |
| Cigna Commercial | PPO/HMO | $2,493 |
| Humana ChoiceCare | All Commercial Plans | $2,493 |
| Novanet | All Commercial Plans | $2,549 |
| Unicare | All Commercial Plans | $2,549 |
| PHCS | All Commercial Plans | $2,549 |
| MultiPlan | PPO/HMO | $2,549 |
| Three Rivers Provider Network | All Commercial Plans | $2,691 |
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