CT abdomen and pelvis with contrast at Jacksonville Memorial Hospital. CPT 74177.
What Jacksonville Memorial Hospital publishes for this service, straight from its standard-charges file, last updated September 17, 2026.
Outpatient / ER
$7,344cash price (self-pay)
$7,344list price
$9.49–$7,822range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medicaid | Illinois Medicaid | $595 |
| Molina HealthCare | Molina Medicaid | $595 |
| Blue Cross Blue Shield | Blue Cross Community MMAI/Dual Eligible | $669 |
| Coventry | Coventry Advantra Medicare Advantage HMO | $717 |
| Health Alliance | Health Alliance Medicare Advantage | $717 |
| Humana | Humana/ChoiceCare Medicare Advantage PPO/HMO | $717 |
| Medicare | Medicare | $717 |
| United HealthCare | United HealthCare Medicare Advantage | $753 |
| Tricare | Tricare | $808 |
| WellCare Medicare Advantage PPO | WellCare Medicare Advantage PPO | $1,156 |
| UHC Va Ccn | UHC Va Ccn | $1,175 |
| Commercial Workers Compensation | Commercial Workers Compensation | $1,861 |
| Corvel/CorCare | Corvel/CorCare | $2,356 |
| Illinois Workers Compensation | Illinois Workers Compensation | $2,428 |
| Health Alliance | Health Alliance Fully Insured/Self Funded/ACA | $3,319 |
| Health Alliance MH Employee plan | Health Alliance MH Employee plan | $3,378 |
| Healthlink | Healthlink HMO | $3,646 |
| 6 Degrees Health | 6 Degrees Health | $4,406 |
| Hope Trust | Hope Trust | $4,406 |
| Hst | Hst | $4,406 |
| Cigna | Cigna | $5,089 |
| United Healthcare | United Healthcare PPO | $5,288 |
| Current Health Network | Current Health Network | $5,508 |
| Aetna | Aetna PPO | $5,671 |
| Humana/ChoiceCare | Humana/ChoiceCare | $6,264 |
| PHCS/Multiplan | PHCS/Multiplan PPO | $6,610 |
| Hfn | Hfn PPO | $6,977 |
| HFN | HFN Workers Compensation | $6,977 |
| Blue Cross Blue Shield | BCBS PPO/HMO/Employee | $7,344 |
| Liability | Liability | $7,344 |
Inpatient
$7,344cash price (self-pay)
$7,344list price
$3,378–$7,822range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Health Alliance MH Employee plan | Health Alliance MH Employee plan | $3,378 |
| Current Health Network | Current Health Network | $4,039 |
| 6 Degrees Health | 6 Degrees Health | $4,406 |
| Hope Trust | Hope Trust | $4,406 |
| Hst | Hst | $4,406 |
| Cigna | Cigna | $5,089 |
| Aetna | Aetna PPO | $5,133 |
| Humana/ChoiceCare | Humana/ChoiceCare | $6,264 |
| Hfn | Hfn PPO | $6,977 |
| HFN | HFN Workers Compensation | $6,977 |
| Blue Cross Blue Shield | BCBS PPO/HMO/Employee | $7,344 |
| Liability | Liability | $7,344 |
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