CT abdomen and pelvis with contrast at Ascension Alexian Brothers Behavioral Health Hospital. CPT 74177.
What Ascension Alexian Brothers Behavioral Health Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
—cash price (self-pay)
—list price
$570–$2,557range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna HMO | 1717_aetna HMO (Ab,Sa) 20240101 | $570 |
| Cigna | 1614_cigna (Ab,Sa) 20231001 | $2,507 |
| Cigna C5 | 1298_cigna C5 (Ab,Sa) 20230201 | $2,507 |
| Cigna Local Plus | 1714_cigna Local Plus (Ab,Sa) 20240101 | $2,507 |
Inpatient
—cash price (self-pay)
—list price
$570–$2,557range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Family Health Plan | 1750_medicaid Advantage Family Health Plan (Sa) 2 | $2,557 |
| Medicaid Replacement 100% | 1736_medicaid Advantage Molina 20240301 | $2,557 |
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All common services at Ascension Alexian Brothers Behavioral Health Hospital