CT abdomen and pelvis with contrast at Ascension Saint Thomas Hickman. CPT 74177.
What Ascension Saint Thomas Hickman publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
—cash price (self-pay)
—list price
$248–$819range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| BCBS Aca Exchange | 3147_sttn Blue Cross Blue Shield Network E 2024123 | $248 |
| BCBS Aca Exchange | 3146_mttn Blue Cross Blue Shield Network E 2024123 | $328 |
| BCBS Missionpoint | 2422_blue Cross Blue Shield Missionpoint Regional | $366 |
| BCBS Network E | 3149_blue Cross Blue Shield Network E Regional 202504 | $377 |
| BCBS Network L | 3150_blue Cross Blue Shield Network L Regional 202504 | $411 |
| BCBS Select | 3182_blue Cross Blue Shield Select Regional 20250701 | $411 |
| BCBS Preferred | 3181_blue Cross Blue Shield Preferred Regional 202507 | $444 |
| Aetna (Rutherford Only) | 3160_mttn Aetna 20250701 | $552 |
| Aetna | 3159_sttn Aetna 20250701 | $563 |
| UHC | 3171_mttn UHC 20250715 | $611 |
| UHC | 3172_rptn UHC 20250715 | $611 |
| UHC | 3173_rhtn UHC 20250715 | $611 |
| UHC | 3174_sdtn UHC 20250715 | $611 |
| UHC | 3175_thtn UHC 20250715 | $611 |
| UHC | 3176_uhc (Sttn) 20250715 | $611 |
| Cigna Localplus | 3192_rhtn Cigna Localplus 20250601 | $669 |
| Cigna Localplus | 3193_cigna Localplus (Dekalb) 20250601 | $669 |
| Cigna Localplus | 3187_sttn Cigna Localplus 20250601 | $730 |
| Cigna PPO | 3199_cigna PPO (Dekalb) 20250601 | $810 |
| Cigna HMO | 3196_cigna HMO (Dekalb) 20250601 | $819 |
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