CT abdomen and pelvis with contrast at Medicine Lodge Memorial Hospital. CPT 74177.
What Medicine Lodge Memorial Hospital publishes for this service, straight from its standard-charges file, last updated August 5, 2026.
Outpatient / ER
$779cash price (self-pay)
$779list price
$456–$779range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| BCBS Blue Choice | BCBS Blue Choice | $456 |
| BCBS Cap - All Other Plans | BCBS Cap - All Other Plans | $480 |
| Tricare West-All Plans | Tricare West-All Plans | $562 |
| Humana Mcr Adv-All Plans | Humana Mcr Adv-All Plans | $639 |
| Aetna Mcr Adv | Aetna Mcr Adv | $639 |
| Aetna Comm-All Other Plans | Aetna Comm-All Other Plans | $721 |
| Aetna/First Health Network | Aetna/First Health Network | $740 |
| Hpk-All Plans | Hpk-All Plans | $740 |
| UHC-All Plans | UHC-All Plans | $740 |
| Aetna Better Health Mcaid Chip | Aetna Better Health Mcaid Chip | $779 |
| Sunflower Mcaid-All Plans | Sunflower Mcaid-All Plans | $779 |
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