CT abdomen and pelvis with contrast at Peninsula Behavioral Health. CPT 74177.
What Peninsula Behavioral Health publishes for this service, straight from its standard-charges file, last updated August 5, 2026.
Outpatient / ER
—cash price (self-pay)
—list price
$316–$639range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna | Commercial | $316 |
| Optum | VA CCN | $317 |
| Tricare | Humana Military | $317 |
| Humana | DSNP | $326 |
| Humana | Medicare Advantage | $326 |
| American Health Plan | ISNP | $332 |
| Blue Cross of TN | BlueEssential DSNP | $332 |
| Blue Cross of TN | BlueEssential HMO | $332 |
| Blue Cross of TN | Med Adv Diamond | $332 |
| Blue Cross of TN | Med Adv PPO | $332 |
| Blue Cross of TN | Med Adv Ruby | $332 |
| Blue Cross of TN | Med Adv Sapphire | $332 |
| Cigna | Medicare HMO-POS | $332 |
| Cigna | Medicare PPO | $332 |
| Devoted Health | HMO | $332 |
| Devoted Health | PPO | $332 |
| NHC Advantage | ISNP | $332 |
| Wellcare | Medicare Advantage | $332 |
| Ambetter | Exchange | $639 |
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