CT abdomen and pelvis with contrast at Pali Momi Medical Center. CPT 74177.
What Pali Momi Medical Center publishes for this service, straight from its standard-charges file, last updated February 12, 2026.
Outpatient / ER
$1,965cash price (self-pay)
$3,923list price
$181–$3,384range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blended Rate UHC | All Products | $181 |
| Hmsa | Quest Abd | $181 |
| UHC | All Products | $181 |
| Alohacare | Abd - Pediatric | $214 |
| Alohacare | Abd - Adult | $214 |
| Ohana | Quest - Abd | $220 |
| Mdx | All Products | $331 |
| Alohacare | Medicare Advantage | $350 |
| Hmsa | Medicare Advantage | $350 |
| Mdx | UHC Medicare | $350 |
| Mdx | Humana Medicare | $350 |
| Ohana | Medicare Advantage | $364 |
| Devoted | Medicare Advantage | $367 |
| Ohana | Quest - Non-Abd | $423 |
| Alohacare | Non-Abd - Adult | $466 |
| Alohacare | Non-Abd - Pediatric | $466 |
| Hmsa | Quest Non-Abd | $490 |
| Hwmg/Hmaa | All Products | $538 |
| Hcha | All Products | $760 |
| Verdegard | Union Trust Fund | $760 |
| Hmsa | All Products | $901 |
| Calvos | Select Care | $2,942 |
| Mimoh | All Products | $2,942 |
| Kaiser | All Products | $3,138 |
| Coventry | All Products | $3,335 |
| Mccp | All Products | $3,335 |
| Multiplan | All Products | $3,335 |
Inpatient
$1,965cash price (self-pay)
$3,923list price
$2,456–$3,384range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Multiplan | All Products | $3,138 |
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