CT abdomen and pelvis with contrast at IU Health White Memorial Hospital. CPT 74177.
What IU Health White Memorial Hospital publishes for this service, straight from its standard-charges file, last updated March 25, 2026.
Outpatient / ER
$676cash price (self-pay)
$2,168list price
$520–$1,995range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Managed Health Services | All Government Medicaid | $632 |
| Caresource | All Managed Medicaid | $632 |
| United Healthcare | All Managed Medicaid | $632 |
| Elevance Health | All Managed Medicaid | $632 |
| Managed Health Services | All Government Medicaid HIP | $632 |
| Elevance Health | All Government Medicaid HIP | $632 |
| Caresource | All Government Medicaid HIP | $632 |
| Self-Pay | Other - Self-Pay | $676 |
| Elevance Health | All PPO | $725 |
| Elevance Health | All Traditional Plans | $725 |
| Elevance Health | All HMO/POS | $725 |
| Elevance Health | All IUHP Employee Plans | $725 |
| Sagamore Health Network/Cigna | PPO - NON-DRG | $725 |
| Aetna | POS - Cox Medical Plans | $725 |
| SIHO Insurance Services | HMO/POS Plans | $725 |
| Encore Health Network | PPO/HMO/EPO - Combined/Encircle | $725 |
| Aetna | PPO - IN Preferred | $725 |
| Encore Health Network | PPO | $725 |
| Sagamore Health Network/Cigna | PPO - DRG Plans | $725 |
| Aetna | HMO - Coventry Plans | $725 |
| SIHO Insurance Services | All PPO Plans | $725 |
| Aetna | PPO/POS | $725 |
| SIHO Insurance Services | PPO - Union Health | $725 |
| United Healthcare | All Managed Care | $725 |
| Indiana Health Network (IHN) | All Managed Care | $1,128 |
| Suburban Health Organization | PPO - Witham Health Services | $1,138 |
| Aetna | PPO - First Health | $1,257 |
| Deaconess Health System | All Managed Care | $1,257 |
| Aetna | PPO - NAP | $1,257 |
| Community Health Direct | HMO - LaPorte Regional Plans | $1,279 |
Inpatient
$1,034cash price (self-pay)
$3,315list price
$1,034–$3,050range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Self-Pay | Other - Self-Pay | $1,034 |
| Encore Health Network | PPO | $1,227 |
| SIHO Insurance Services | PPO - Union Health | $1,359 |
| Elevance Health | All HMO/POS | $1,562 |
| Elevance Health | All PPO | $1,683 |
| Elevance Health | All IUHP Employee Plans | $1,683 |
| Indiana Health Network (IHN) | All Managed Care | $1,725 |
| Suburban Health Organization | PPO - Witham Health Services | $1,740 |
| Suburban Health Organization | PPO - Direct | $1,740 |
| Aetna | HMO - Coventry Plans | $1,774 |
| Aetna | PPO/POS | $1,774 |
| Aetna | PPO - IN Preferred | $1,783 |
| Aetna | POS - Cox Medical Plans | $1,783 |
| United Healthcare | All Managed Care | $1,907 |
| Aetna | PPO - NAP | $1,923 |
| Aetna | PPO - First Health | $1,923 |
| Community Health Direct | HMO - LaPorte Regional Plans | $1,956 |
| Parkview Health | HMO - Employee Plans | $2,049 |
| Unified Group Services | HMO | $2,055 |
| Sagamore Health Network/Cigna | PPO - DRG Plans | $2,088 |
| Cigna | HMO/POS - Arnett Hospital Plans | $2,088 |
| Cigna | PPO | $2,088 |
| Sagamore Health Network/Cigna | PPO - NON-DRG | $2,088 |
| Cigna | HMO - Open Access | $2,088 |
| Cigna | HMO | $2,088 |
| Elevance Health | All Traditional Plans | $2,283 |
| Lutheran Health Network | All Managed Care | $2,321 |
| Parkview Health | EPO | $2,390 |
| Lutheran Preferred | All PPO Plans | $2,652 |
| Parkview Health | PPO | $2,732 |
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