CT abdomen and pelvis with contrast at Jeff Davis Hospital. CPT 74177.
What Jeff Davis Hospital publishes for this service, straight from its standard-charges file, last updated May 26, 2026.
Outpatient / ER
$2,237cash price (self-pay)
$6,392list price
$436–$7,883range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Pen_network | Medicare | $436 |
| Medicaid | Medicaid | $1,246 |
| Humana_medicaid | Medicaid | $1,271 |
| Peach_state | Commercial | $1,271 |
| Molina_medicaid | Medicaid | $1,284 |
| Medicare | Medicare | $1,982 |
| Choicecare_medicare_ppo | Medicare | $2,001 |
| Humana_medicare_hmo | Medicare | $2,001 |
| Humana_medicare_pffs | Medicare | $2,001 |
| Humana_medicare_pos | Medicare | $2,001 |
| Humana_medicare_ppo | Medicare | $2,001 |
| Bcbs_medicare_advantage_hmo | Medicare | $2,021 |
| Bcbs_medicare_advantage_indemnity | Medicare | $2,021 |
| Bcbs_medicare_advantage_open_access | Medicare | $2,021 |
| Bcbs_medicare_advantage_par | Medicare | $2,021 |
| Bcbs_medicare_advantage_pos | Medicare | $2,021 |
| Bcbs_medicare_advantage_ppo | Medicare | $2,021 |
| Care_improvement_plus | Medicare | $2,021 |
| Amerigroup_medicaid | Medicaid | $3,426 |
| Coventry_hmo | Commercial | $4,474 |
| Coventry_pos | Commercial | $4,474 |
| Bcbs_hmo | Commercial | $4,794 |
| Bcbs_pos | Commercial | $4,794 |
| Bcbs_ppo | Commercial | $4,794 |
| Coventry_ppo | Commercial | $4,922 |
| Beech_street | Commercial | $5,114 |
| Care_source | Medicaid | $5,114 |
| Cigna | Commercial | $5,114 |
| One_health_ppo | Commercial | $5,114 |
| Choicecare | Commercial | $5,433 |
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