CT abdomen and pelvis with contrast at Medical City Fort Worth Hospital. CPT 74177.
What Medical City Fort Worth Hospital publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$16,685cash price (self-pay)
$16,685list price
$312–$16,685range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| United | NarrowNetworkIndivExchange | $341 |
| United | SmallGroup | $341 |
| Molina | CHIP | $346 |
| Molina | MCDSTAR | $346 |
| Molina | STAR+PLUS | $346 |
| Molina | STARKIDS | $346 |
| United | AllPayerAppendix | $828 |
| Superior Health Plan | CHIP | $1,168 |
| Superior Health Plan | MCDSTAR | $1,168 |
| Superior Health Plan | STARHealth | $1,168 |
| Superior Health Plan | STARKids | $1,168 |
| Superior Health Plan | STARPLUS | $1,168 |
| Cigna | IFP | $2,253 |
| Cigna | QHP | $2,336 |
| Unicare | CHIP | $3,671 |
| Healthcare Highways | CityofPlano | $5,640 |
| BCBS | Traditional | $6,908 |
| City of McKinney | COMM | $7,508 |
| Fidelis SecureCare | MGMCR | $7,508 |
| United | GlobalBenefitPlan | $7,508 |
| National ChoiceCare | WCOMP | $8,343 |
| Aetna | ASA | $8,426 |
| Aetna | WCOMP | $9,177 |
| PC Texas Partners | WCOMP | $9,177 |
| Physicians Coop of TX | MGMCR | $9,177 |
| Rockport Health Group | WORKERSCOMP | $9,177 |
| Aetna Coventry First Health | EXCLUSIVE | $9,561 |
| Aetna Coventry First Health | NONEXCLUSIVE | $9,561 |
| Averde Health, Inc | PPO | $9,678 |
| Emerging Therapy Solutions | Commercial | $11,179 |
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