CT abdomen and pelvis with contrast at Licking Memorial Hospital. CPT 74177.
What Licking Memorial Hospital publishes for this service, straight from its standard-charges file, last updated March 16, 2026.
Outpatient / ER
$8,470cash price (self-pay)
$8,470list price
$330–$8,470range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| BeniComp [70090] | BeniComp [13] | $6,352 |
| Consociate Health [100029] | Consociate Health [10002901] | $6,776 |
| Consociate Health 6 Degrees [100059] | Consociate Life 6 Degrees [1000 | $6,776 |
| Gravie Administrative Services [100165] | Gravie Administrative Servic | $6,928 |
| Aetna [100001] | Boon-Chapman [1000110] | $6,928 |
| Aetna [100001] | Aetna PPO [10000101] | $6,928 |
| Aetna [100001] | Aetna American Continental Supplement [10000102] | $6,928 |
| Aetna [100001] | Aetna Strategic Resource [10000103] | $6,928 |
| Aetna [100001] | Aetna Senior Supplement [10000104] | $6,928 |
| Aetna [100001] | Aetna HMO [10000107] | $6,928 |
| Aetna [100001] | Aetna Afbp Boon [10000109] | $6,928 |
| Aetna [100001] | Aetna Trinity Health [10000111] | $6,928 |
| Aetna [100001] | Aetna Insurance [1000010103] | $6,928 |
| Aetna [100001] | Aetna Insurance [1000010104] | $6,928 |
| Allied Benefit Systems [100015] | Allied Benefit Systems [10001501] | $6,928 |
| Allied Benefit Systems [100015] | Allied Benefit Systems Phs [10001501 | $6,928 |
| Geha [100039] | Geha [10003901] | $6,928 |
| Geha [100039] | Geha Asa [10003902] | $6,928 |
| Geha [100039] | Geha Phcs Network [1000390101] | $6,928 |
| Aetna [100001] | Aetna Owens Corning [1000010101] | $6,996 |
| Aetna [100001] | Aetna Denison [1000010102] | $6,996 |
| Surest [100016] | Surest [10001601] | $7,199 |
| Coresource [100002] | Coresource [1000020102] | $7,623 |
| Cigna [100009] | Cigna [10000901] | $7,623 |
| Cigna [100009] | Cigna Great West [10000902] | $7,623 |
| Cigna [100009] | Cigna Behavioral Health [10000903] | $7,623 |
| Cigna [100009] | Cigna National Assoc Letter Carriers [10000904] | $7,623 |
| Cigna [100009] | Cigna Medicare Supplement [10000910] | $7,623 |
| Cigna [100009] | Connecticut General Life [10000911] | $7,623 |
| Cigna [100009] | Cigna Pa [10000913] | $7,623 |
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