CT abdomen and pelvis with contrast at Dupont Hospital. CPT 74177.
What Dupont Hospital publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$840cash price (self-pay)
$7,686list price
$280–$6,917range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| NODE Tricare | NODE Tricare | $351 |
| Department of Veterans Affairs | NODE ChampVA | $369 |
| Anthem BCBS | Anthem IN Medicaid | $632 |
| CareSource | CareSource HHW IN Medicaid | $632 |
| CareSource | CareSource IN HIP | $632 |
| Humana PathWays IN Medicaid | Humana PathWays IN Medicaid | $632 |
| Medicaid | IN Medicaid | $632 |
| Medicaid Non-Par | IN Medicaid Non-Par | $632 |
| Managed Health Services | MHS HCC IN Medicaid | $632 |
| Managed Health Services | MHS HHW IN Medicaid | $632 |
| Managed Health Services | MHS IN HIP | $632 |
| Physicians Health Plan | PHP Options | $674 |
| Physicians Health Plan | PHP Classic Network | $761 |
| Encore PPO | Encore Combined PPO | $788 |
| PHP Freedom Network | PHP Freedom Network | $924 |
| Lutheran Preferred | Lutheran Preferred Three Rivers Plus | $2,009 |
| Amish Aid | Amish Aid | $2,075 |
| Lutheran Preferred | Lutheran Preferred Exclusive Plus | $2,115 |
| Lutheran Network | Lutheran Preferred Exclusive Plus MRM | $2,115 |
| Lutheran Preferred | Lutheran Preferred Fixed | $2,115 |
| Lutheran Preferred | Lutheran Preferred Inclusive | $2,115 |
| Lutheran Preferred | Lutheran Preferred Three Rivers | $2,115 |
| Lutheran Preferred | Lutheran Preferred Exclusive | $2,221 |
| Lutheran Preferred | Lutheran Preferred CHS Employees | $2,283 |
| Cigna | Cigna HMO | $2,483 |
| Cigna | Cigna PPO | $2,790 |
| Aetna | Aetna NBD | $2,844 |
| Aetna PSSD J and J | Aetna PSSD JJ | $2,844 |
| Physicians Health Plan | PHP Platinum Network | $2,976 |
| Aetna | Aetna | $3,436 |
Inpatient
$1,400cash price (self-pay)
$7,686list price
$924–$6,917range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Lutheran Preferred | Lutheran Preferred CHS Employees | $2,283 |
| Cigna | Cigna HMO | $2,483 |
| Cigna | Cigna PPO | $2,790 |
| Aetna | Aetna NBD | $2,844 |
| Aetna PSSD J and J | Aetna PSSD JJ | $2,844 |
| Physicians Health Plan | PHP Platinum Network | $2,976 |
| Aetna | Aetna | $3,436 |
| Self Pay | Self Pay | $3,459 |
| Medical Mutual of OH | Medical Mutual of Ohio | $4,074 |
| Lutheran Preferred | Lutheran Preferred Choice | $4,227 |
| Lutheran Preferred | Lutheran Preferred Exclusive | $4,227 |
| Lutheran Preferred | Lutheran Preferred CCSI | $4,612 |
| Prime Health Services | Prime Health Services | $5,765 |
| Prime Health Services | Prime Health Services Auto | $5,765 |
| FrontPath | FrontPath Health Coalition | $6,149 |
| Encore Health Network | Encore Fully Funded | $6,303 |
| Advantage Health Solutions | Advantage Health Solutions | $6,379 |
| Multiplan | Multiplan PPO Primary Network | $6,610 |
| Allied Benefit Systems | Allied Benefit Systems | $6,917 |
| Encore Health Network | Encore Self Funded | $6,917 |
| Multiplan | Multiplan PPO Complimentary Network | $6,917 |
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