CT abdomen and pelvis with contrast at Le Bonheur Children's Hospital. CPT 74177.
What Le Bonheur Children's Hospital publishes for this service, straight from its standard-charges file, last updated March 19, 2026.
Outpatient / ER
$2,047cash price (self-pay)
$9,305list price
$7.73–$8,840range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| CIGNA [100009] | HB Cigna PPO - LeBonheur | $7.73 |
| Ar - Medicaid [300005] | Hb Medicaid-Ar Contract | $206 |
| Ar Medicaid Replacement [350010] | Hb Xr Ar Passe Caid/Caresource/Empo | $206 |
| Wellpoint Medicaid [350002] | Hb Amerigroup-Wellpoint Lebonheur Cont | $234 |
| CIGNA [100009] | HB Cigna EPO Le Bonheur | $247 |
| MS - MEDICAID [300025] | HB MEDICAID MS - TN Locations | $285 |
| MS - MEDICAID [300025] | HB MEDICAID MS - MAGNOLIA HEALTHCARE - TN Loc | $285 |
| Ms - Medicaid [300025] | Hb Molina Hc Of Ms - Mscan Mlh-Tn Contract | $285 |
| Molina Healthcare [350012] | Hb Molina Hc Of Ms - Mscan Mlh-Tn Contrac | $285 |
| BCBS MEDICAID REPLACEMENT [350011] | HB BLUECARE TN - LeBonheur | $311 |
| Alt BCBS MS Medicare [450116] | HB MEDICARE ADVANTAGE / MANAGED CARE - | $327 |
| Shared Health Of Ms - Medicare Advantage [450074] | Hb Medicare Advant | $327 |
| Alt BCBS TN Medicare [450115] | HB MEDICARE ADVANTAGE / MANAGED CARE - | $327 |
| American Health Advantage MCR ADV [450117] | HB MEDICARE ADVANTAGE / M | $327 |
| BCBS Medicare Advantage [450110] | Hb Medicare Advantage / Managed Car | $327 |
| Humana Medicare Advantage [450013] | Hb Medicare Advantage / Managed C | $327 |
| Optum Medicare Advantage [450112] | Hb Medicare Advantage / Managed CA | $327 |
| Generic Hospice Vbid [10940000101] | Hb Medicare Advantage / Managed C | $327 |
| Carecentrix [450200] | Hb Medicare Advantage / Managed Care - Tn Contr | $327 |
| Medipak Advantage - BCBS Ar [450040] | Hb Medicare Advantage / Managed | $327 |
| Transplant Optum Medicare [450095] | Hb Medicare Advantage / Managed C | $327 |
| Healthy Mississippi - Medicare Advantage HMO [450114] | Hb Medicare Ad | $327 |
| Medicare [400001] | Hb Medicare-Tn Contract | $327 |
| Healthsprings Medicare Advantage [450007] | Hb Medicare Advantage / MA | $327 |
| United Healthcare Medicare [450021] | Hb Medicare Advantage / Managed | $327 |
| Devoted Health [450111] | Hb Medicare Advantage Devoted - Tn Contract | $337 |
| Molina Healthcare [350012] | Hb Molina Mschips - Mlh-Tn Contract | $356 |
| BCBS Medicaid Replacement [350011] | Hb Xr Tncare Select Lebonheur Chi | $435 |
| CIGNA [100009] | HB CIGNA IFP - LeBonheur | $456 |
| CIGNA [100009] | HB CIGNA HMO - LeBonheur | $506 |
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