CT abdomen and pelvis with contrast at Medical City Lewisville Hospital. CPT 74177.
What Medical City Lewisville Hospital publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$17,973cash price (self-pay)
$17,973list price
$307–$17,973range 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 | $1,258 |
| Superior Health Plan | MCDSTAR | $1,258 |
| Superior Health Plan | STARHealth | $1,258 |
| Superior Health Plan | STARKids | $1,258 |
| Superior Health Plan | STARPLUS | $1,258 |
| Cigna | IFP | $2,426 |
| Cigna | QHP | $2,516 |
| United | OptionsPPO | $3,469 |
| Unicare | CHIP | $4,314 |
| Healthcare Highways | CityofPlano | $6,075 |
| BCBS | Traditional | $7,441 |
| City of McKinney | COMM | $8,088 |
| Fidelis SecureCare | MGMCR | $8,088 |
| United | GlobalBenefitPlan | $8,088 |
| National ChoiceCare | WCOMP | $8,987 |
| Aetna | ASA | $9,077 |
| Aetna | WCOMP | $9,885 |
| PC Texas Partners | WCOMP | $9,885 |
| Physicians Coop of TX | MGMCR | $9,885 |
| Rockport Health Group | WORKERSCOMP | $9,885 |
| Aetna Coventry First Health | COMM | $10,299 |
| Averde Health, Inc | PPO | $10,425 |
| Coastal Comp Health Networks | WCOMP | $12,581 |
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