CT abdomen and pelvis with contrast at Memorial Hospital and Manor. CPT 74177.
What Memorial Hospital and Manor publishes for this service, straight from its standard-charges file, last updated May 1, 2026.
Outpatient / ER
$4,158cash price (self-pay)
$5,940list price
$299–$5,643range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Tricare_plan | Medicare | $299 |
| Aetna_medicare_plan | Medicare | $322 |
| Humana_medicare_plan | Medicare | $322 |
| Medicare_plan | Medicare | $322 |
| Uhc_medicare_plan | Medicare | $322 |
| Wellcare_plan | Medicare | $322 |
| Ambetter_plan | Medicare | $418 |
| Tnga_plan | Commercial | $450 |
| Alliant_plan | Medicare | $515 |
| Amerigroup_plan | Medicaid | $3,742 |
| Medicaid__plan | Medicaid | $3,742 |
| Peach_state_health_plan_plan | Medicaid | $3,742 |
| Caresource_plan | Medicaid | $3,926 |
| Anthem_plan | Commercial | $4,587 |
| Humana_commercial_plan | Commercial | $4,633 |
| Aetna_plan | Commercial | $4,693 |
| Uhc_plan | Commercial | $4,693 |
| Humana_choice_care_plan | Commercial | $4,752 |
| Novanet_plan | Commercial | $4,752 |
| Cigna_plan | Commercial | $4,930 |
| Private_healthcare_systems_plan | Commercial | $5,049 |
| Aetna_medical_rental_plan | Commercial | $5,346 |
| Multiplan_plan | Commercial | $5,346 |
| Corvel_plan | Commercial | $5,643 |
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