CT abdomen and pelvis with contrast at Adena Pike Medical Center. CPT 74177.
What Adena Pike Medical Center publishes for this service, straight from its standard-charges file, last updated August 19, 2026.
Outpatient / ER
$2,016cash price (self-pay)
$4,032list price
$713–$3,831range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Molina Marketplace | Commercial | $713 |
| Care Source Just4Me | Commercial | $713 |
| Molina | Medicare Advantage | $968 |
| Humana | Medicare Advantage | $968 |
| Medigold | Medicare Advantage | $968 |
| Medical Mutual of Ohio | Medicare Advantage | $968 |
| Buckeye Community Health Plan | Medicare Advantage | $968 |
| Aetna | Medicare Advantage | $968 |
| Care Source | Medicare Advantage | $987 |
| First Health | Commercial | $1,250 |
| Aetna (Cofinity/Meritain) | Commercial | $1,250 |
| Anthem | Medicare Advantage | $1,250 |
| Gateway Health | Commercial | $1,331 |
| Anthem Ohio Exchange | PPO | $2,657 |
| Anthem Ohio Exchange | HMO | $2,657 |
| Sidecar Health | Commercial | $2,661 |
| The Health Plan | Commercial | $2,823 |
| Ohio PPO Connect | Commercial | $2,823 |
| Medical Mutual of Ohio SuperMed | Commercial | $2,894 |
| Medical Mutual of Ohio | Managed Care | $2,894 |
| Great West Health Care/Cigna | Commercial | $2,919 |
| Anthem | Traditional | $2,988 |
| Ohio Health Choice | Commercial | $3,210 |
| United Healthcare | All Plans | $3,379 |
| Anthem Pathway | HMO/PPO | $3,480 |
| Integrated Health Plan | Commercial | $3,791 |
| HealthSmart | Emerald Commercial Products | $3,831 |
| Multiplan/Private Healthcare Systems | Commercial | $3,831 |
| Three Rivers Network | Commercial | $3,831 |
Inpatient
$2,016cash price (self-pay)
$4,032list price
$2,557–$3,831range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem Ohio Exchange | HMO | $2,557 |
| Anthem Ohio Exchange | PPO | $2,557 |
| Ohio PPO Connect | Commercial | $2,823 |
| The Health Plan | Commercial | $2,823 |
| Medical Mutual of Ohio | Managed Care | $2,894 |
| Medical Mutual of Ohio SuperMed | Commercial | $2,894 |
| Great West Health Care/Cigna | Commercial | $2,919 |
| Anthem | Traditional | $2,988 |
| First Health | Commercial | $3,161 |
| Ohio Health Choice | Commercial | $3,210 |
| Aetna (Cofinity/Meritain) | Commercial | $3,282 |
| Anthem Pathway | HMO/PPO | $3,387 |
| Integrated Health Plan | Commercial | $3,791 |
| Three Rivers Network | Commercial | $3,831 |
| Multiplan/Private Healthcare Systems | Commercial | $3,831 |
| HealthSmart | Emerald Commercial Products | $3,831 |
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