CT abdomen and pelvis with contrast at TMC Bonham Hospital. CPT 74177.
What TMC Bonham Hospital publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$4,901cash price (self-pay)
$6,534list price
$485–$4,051range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Molina_chip | Medicaid | $485 |
| Superior_star_plus | Medicaid | $605 |
| Uhc_star_plus | Medicaid | $605 |
| Molina_star_plus | Medicaid | $635 |
| Wellpoint_star_plus | Medicaid | $635 |
| Superior_star | Medicaid | $646 |
| Uhc_star | Medicaid | $646 |
| Molina_star | Medicaid | $679 |
| Superior_chip | Medicaid | $679 |
| Wellpoint | Medicaid | $679 |
| Aetna_medicare | Medicare | $1,372 |
| Humana_choice_care | Medicare | $1,372 |
| United_healthcare | Medicare | $1,372 |
| Ambetter | Qhp | $2,154 |
| Cigna | HMO | $2,542 |
| Aetna | PPO | $3,411 |
| Blue_cross_blue_shield_of_tx | Managed_care | $4,051 |
| Blue_cross_blue_shield_of_tx | HMO | $4,051 |
| Blue_cross_blue_shield_of_tx | PPO | $4,051 |
| Blue_cross_blue_shield_of_tx | Qhp | $4,051 |
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