CT abdomen and pelvis with contrast at Memorial Hospital of South Bend. CPT 74177.
What Memorial Hospital of South Bend publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$3,236cash price (self-pay)
$4,978list price
$201–$4,978range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| McLaren | MI Medicaid | $201 |
| UHC | MI Medicaid | $201 |
| Anthem | Exchange | $374 |
| Anthem | Medicare Advantage | $374 |
| Humana | Medicare Advantage | $374 |
| PACE | Medicare | $374 |
| Caresource | Exchange | $599 |
| Anthem | IN Medicaid HCC | $632 |
| Anthem | IN Medicaid HHW | $632 |
| Anthem | IN Medicaid HIP | $632 |
| Anthem | Pathways for Aging | $632 |
| Caresource | IN Medicaid HHW | $632 |
| Caresource | IN Medicaid HIP | $632 |
| Humana | Pathways for Aging | $632 |
| MHS | IN Medicaid HCC | $632 |
| MHS | IN Medicaid HHW | $632 |
| MHS | IN Medicaid HIP | $632 |
| MdWise | IN Medicaid HHW | $632 |
| MdWise | IN Medicaid HIP | $632 |
| UHC | IN Medicaid HCC | $632 |
| Anthem | Workers Compensation | $711 |
| Devoted Healthcare | Medicare Advantage | $996 |
| Anthem | Commercial (excludes Granger) | $1,001 |
| Anthem | HealthSync | $1,001 |
| Anthem | Commercial (Granger) | $1,143 |
| Aetna | Medicare Advantage | $2,240 |
| CHA | Employer Group 4 | $2,987 |
| Immergrun | Commercial | $2,987 |
| MHS | Exchange | $3,236 |
| Cigna | OAP | $3,485 |
Inpatient
$3,236cash price (self-pay)
$4,978list price
$996–$4,082range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Devoted Healthcare | Medicare Advantage | $996 |
| Multiplan | Commercial | $3,236 |
| Cigna | OAP | $3,485 |
| UHC | Commercial | $3,594 |
| Humana | Commercial | $3,634 |
| Aetna | Commercial | $3,664 |
| CHA | Employer Group 5 | $3,734 |
| CHA | Employer Group 6 | $3,982 |
| Cigna BH | Commercial | $3,982 |
| Immergrun | Commercial | $3,982 |
| Plain Church | Commercial | $3,982 |
| Cigna | PPO | $4,082 |
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