CT abdomen and pelvis with contrast at Diley Ridge Medical Center. CPT 74177.
What Diley Ridge Medical Center publishes for this service, straight from its standard-charges file, last updated March 31, 2026.
Outpatient / ER
$2,080cash price (self-pay)
$3,200list price
$296–$3,200range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Hospice Mount Carmel | Mount Carmel Hospice | $336 |
| Enterprise Group Planning | Enterprise Group Planning Medicare Adv | $649 |
| Custom Design Benefits | Custom Design Benefit | $703 |
| Cigna | Cigna | $1,126 |
| Blue Cross - Or (Regence) | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Cross - Pa (Independence) | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Cross - Pa (Capital) | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Shield - Pa (Highmark) | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Cross - Ri | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Cross - Sc | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Cross - Tn | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Cross - Va (Anthem) | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Cross - TX | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Cross - Ut (Regence) | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Cross - Vt | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Shield - Id (Regence) | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Cross - Ky (Anthem) | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Cross - La | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Cross - Me (Anthem) | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Cross - Md (Carefirst) | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Cross - MA | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Cross - Ms | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Cross - Mt | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Cross - Nj (Horizon) | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Cross - Nm | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Cross - Nv (Anthem) | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Cross - Nh (Anthem) | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Cross - NY (Anthem) | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Cross - NY (Excellus) | Anthem Blue Access PPO Blue Pref HMO | $1,255 |
| Blue Shield - NY Highmark Western | Anthem Blue Access PPO Blue Pref H | $1,255 |
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