CT abdomen and pelvis with contrast at Covenant Hospital Plainview. CPT 74177.
What Covenant Hospital Plainview publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$2,540cash price (self-pay)
$6,047list price
$340–$1,455range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Bcbs | Vapc3 Government | $340 |
| Aetna | Medicare Managed Care Plan | $350 |
| Superior | Wellcare Medicare Managed Care Plan | $368 |
| Unitedhealthcare | Medicare Managed Care Plan | $370 |
| Baylor Scott And White | Individual Bsw Premier Exchange | $814 |
| Bcbs | Hmo | $878 |
| Bcbs | Ppo | $970 |
| Bcbs | Par Traditional | $974 |
| Baylor Scott And White | Group Bsw Premier/Covenant Preferred All Comm | $985 |
| Baylor Scott And White | Group Bsw Plus All Commercial Plans | $1,013 |
| Bcbs | Ers Hmo | $1,455 |
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