CT abdomen and pelvis with contrast at Methodist Le Bonheur Germantown Hospital. CPT 74177.
What Methodist Le Bonheur Germantown Hospital publishes for this service, straight from its standard-charges file, last updated March 19, 2026.
Outpatient / ER
$1,949cash price (self-pay)
$8,861list price
$50.00–$925range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| UHC Medicaid [350006] | Hb UHC Mschips Ob & Mlh-Tn Adult Hospitals Co | $50.00 |
| UHC Medicaid [350006] | Hb Medicaid Tn - UHC Tenncare (Americhoice) - | $150 |
| BCBS MEDICAID REPLACEMENT [350011] | HB Bluecare Adult Contract | $195 |
| BCBS MEDICAID REPLACEMENT [350011] | HB MEDICAID TN - BCBS TennCare Se | $203 |
| TRANSPLANT BCBS TENNCARE SELECT [350032] | HB MEDICAID TN - BCBS TennC | $203 |
| Ar Medicaid Replacement [350010] | Hb Xr Ar Passe Caid/Caresource/Empo | $206 |
| Wellpoint Medicaid [350002] | Hb Amerigroup-Wellpoint Tn Adult Contrac | $234 |
| Magnolia Medicaid [350020] | Hb Medicaid Ms - Magnolia Healthcare - Tn | $285 |
| 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 |
| UHC Medicaid [350006] | Hb UHC Ms Can Mlh-Ms-Ob Contract | $285 |
| Humana Medicare Advantage [450013] | Hb Medicare Advantage / Managed C | $327 |
| Generic Hospice Vbid [10940000101] | Hb Medicare Advantage / Managed C | $327 |
| Healthy Mississippi - Medicare Advantage HMO [450114] | Hb Medicare Ad | $327 |
| Va Ccn UHC [600003] | Hb Va - Tn Contract | $327 |
| Shared Health Of Ms - Medicare Advantage [450074] | Hb Medicare Advant | $327 |
| Wellcare Medicare [450023] | Hb Medicare Advantage Wellcare/Wellpoint | $327 |
| United Healthcare Medicare [450021] | Hb Medicare Advantage / Managed | $327 |
| Medicare Priority Health [450072] | Hb Medicare Advantage / Managed CA | $327 |
| Alt BCBS MS Medicare [450116] | HB MEDICARE ADVANTAGE / MANAGED CARE - | $327 |
| Wellpoint Medicare [450090] | Hb Medicare Advantage Wellcare/Wellpoint | $327 |
| BCBS Medicare Advantage [450110] | Hb Medicare Advantage / Managed Car | $327 |
| Wellcare By Allwell Ar Medicare Advantage [450099] | Hb Medicare Advan | $327 |
| Medipak Advantage - BCBS Ar [450040] | Hb Medicare Advantage / Managed | $327 |
| Alt BCBS TN Medicare [450115] | HB MEDICARE ADVANTAGE / MANAGED CARE - | $327 |
| Healthsprings Medicare Advantage [450007] | Hb Medicare Advantage / MA | $327 |
| American Health Advantage MCR ADV [450117] | HB MEDICARE ADVANTAGE / M | $327 |
| Transplant Humana Medicare [450093] | Hb Medicare Advantage / Managed | $327 |
| Transplant Optum Medicare [450095] | Hb Medicare Advantage / Managed C | $327 |
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All common services at Methodist Le Bonheur Germantown Hospital