CT abdomen and pelvis with contrast at CAHRMC, dba Rice Medical Center. CPT 74177.
What CAHRMC, dba Rice Medical Center publishes for this service, straight from its standard-charges file.
Outpatient / ER
$2,091cash price (self-pay)
$2,987list price
$464–$2,987range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Molina Medicaid | Medicaid | $464 |
| UnitedHealthcare Commercial | PPO | $851 |
| BCBS HMO/Blue Essentials | HMO | $1,371 |
| BCBS PPO/Traditional | PPO | $1,524 |
| Cigna Commercial | PPO/HMO | $1,598 |
| Humana Medicare Advantage | Medicare Advantage | $1,613 |
| Aetna Medicare Advantage | Medicare Advantage | $1,613 |
| BCBS Medicare Advantage | Medicare Advantage | $1,629 |
| Aetna Commercial | PPO/HMO | $2,150 |
| TML Intergovernmental Employee Benefits | Unknown | $2,539 |
| Superior | Medicaid | $2,987 |
Inpatient
$2,091cash price (self-pay)
$2,987list price
$1.00–$2,688range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Scott and White Medicaid | Medicaid | $1.00 |
| Wellpoint Medicaid | Medicaid | $1.00 |
| Community Health Choice Medicaid | Medicaid | $1.00 |
| Molina Medicaid | Medicaid | $1.00 |
| BCBS HMO/Blue Essentials | HMO | $1,792 |
| BCBS Blue Advantage | Blue Advantage | $1,792 |
| BCBS PPO/Traditional | PPO | $1,792 |
| Choice One Inc EPO/POS | EPO | $2,150 |
| Medavant Healthcare Solutions | Unknown | $2,389 |
| Choice One Inc PPO | PPO | $2,389 |
| Private Healthcare Systems | Unknown | $2,389 |
| ChoiceCare Network PPO, POS, Med Adv | Medicare Advantage | $2,389 |
| Accountable Health Plans of America | PPO | $2,539 |
| ProAmerica PPO | PPO | $2,539 |
| MedCorp Southwest | Unknown | $2,539 |
| Great West Healthcare of Texas | Unknown | $2,628 |
| Health Industry Trust and Welfare Plan | Unknown | $2,688 |
| Galaxy Health Network | Unknown | $2,688 |
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