CT abdomen and pelvis with contrast at Iraan General Hospital. CPT 74177.
What Iraan General Hospital publishes for this service, straight from its standard-charges file.
Outpatient / ER
$2,983cash price (self-pay)
$4,261list price
$852–$7,513range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Cigna | Commercial | $852 |
| Aetna | Commercial | $3,409 |
| Blue Cross Blue Shield - Tx | Essentials Network Participation | $3,664 |
| Blue Cross Blue Shield - Tx | Commercial | $3,835 |
| Blue Cross Blue Shield - Tx | PPO | $3,835 |
| Superior HealthPlan | Medicare HMO | $5,289 |
| Superior HealthPlan | Medicare PPO | $5,289 |
| Superior HealthPlan | Commercial | $7,513 |
| Superior HealthPlan | EPO | $7,513 |
| Superior HealthPlan | HMO | $7,513 |
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