CT abdomen and pelvis with contrast at Dallam Hartley Counties Hospital District. CPT 74177.
What Dallam Hartley Counties Hospital District publishes for this service, straight from its standard-charges file, last updated May 4, 2026.
Outpatient / ER
$157cash price (self-pay)
$209list price
$83.71–$198range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| BCBS Blue Advantage | PPO | $83.71 |
| Baylor Scott and White Medicare Advantage | HMO | $121 |
| BCBS Blue Essentials HMO | HMO | $132 |
| Cigna Commercial | PPO | $142 |
| BCBS Blue Traditional/PPO | PPO | $147 |
| United Healthcare Commercial | PPO | $163 |
| Provider Network of America | PPO | $182 |
| Baylor Scott and White Medicaid Replacement | HMO | $198 |
Inpatient
$157cash price (self-pay)
$209list price
$1.00–$153range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| United Healthcare Commercial | PPO | $1.00 |
| BCBS Blue Advantage | PPO | $117 |
| BCBS Blue Essentials HMO | HMO | $132 |
| BCBS Blue Traditional/PPO | PPO | $147 |
| Cigna Commercial | PPO | $153 |
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All common services at Dallam Hartley Counties Hospital District