CT abdomen and pelvis with contrast at Jackson County Memorial Hospital. CPT 74177.
What Jackson County Memorial Hospital publishes for this service, straight from its standard-charges file, last updated December 31, 2025.
Outpatient / ER
$3,200cash price (self-pay)
$3,200list price
$364–$3,040range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Coventry | Medicare Advantage | $364 |
| Humana | Medicare Advantage | $364 |
| Humana | Veteran Services Project Hero | $364 |
| Blue Cross Blue Shield Of Oklahoma | Blue Advantage | $964 |
| Blue Cross Blue Shield Of Oklahoma | Blue Choice | $964 |
| Blue Cross Blue Shield Of Oklahoma | Blue Lincs | $964 |
| Blue Cross Blue Shield Of Oklahoma | Blue Preferred | $964 |
| Blue Cross Blue Shield Of Oklahoma | Blue Traditional | $964 |
| Healthcare Highways | Sync PPO | $1,920 |
| United Healthcare | PPO | $2,176 |
| Oklahoma Health Network (OHN) | PPO | $2,240 |
| Coventry | PPO | $2,368 |
| Coventry | First Health PPO | $2,560 |
| Phcs | Multiplan Savility PPO | $2,560 |
| Aetna | Gatekeeper | $2,656 |
| Aetna | Non Gatekeeper | $2,720 |
| Cigna | PPO | $2,720 |
| Phcs | Multiplan PPO | $2,880 |
| Preferred Community Choice | PPO | $2,880 |
| Humana | PPO | $3,040 |
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