CT abdomen and pelvis with contrast at Evans Memorial Hospital. CPT 74177.
What Evans Memorial Hospital publishes for this service, straight from its standard-charges file, last updated March 26, 2026.
Outpatient / ER
—cash price (self-pay)
$6,695list price
$304–$5,691range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Humana Medicare | HMO | $304 |
| Ambetter | EPO | $395 |
| Caresource Commercial | EPO | $426 |
| Caresource Medicaid | HMO | $1,035 |
| Amerigroup Medicaid | HMO | $1,055 |
| Peach State Medicaid | HMO | $1,056 |
| Cigna | PPO | $4,017 |
| United Healthcare | PPO | $4,352 |
| Aetna Commercial | PPO | $5,691 |
Inpatient
—cash price (self-pay)
$6,695list price
$4,352–$4,599range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| United Healthcare | PPO | $4,352 |
| Cigna | PPO | $4,599 |
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