CT abdomen and pelvis with contrast at Medical City Surgical Hospital Alliance. CPT 74177.
What Medical City Surgical Hospital Alliance publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$13,581cash price (self-pay)
$13,581list price
$312–$15,883range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Amerigroup | CHIP | $312 |
| Amerigroup | MGMCD | $312 |
| Cigna Healthspring | MGMCD | $328 |
| Aetna Better Health | CHIP | $337 |
| Aetna Better Health | MCD | $337 |
| United | NarrowNetworkIndivExchange | $341 |
| United | SmallGroup | $341 |
| Molina | CHIP | $346 |
| Molina | MCDSTAR | $346 |
| Molina | STAR+PLUS | $346 |
| Molina | STARKIDS | $346 |
| BCBS | BlueAdvantageHMO | $481 |
| BCBS | MyBlueHealth | $481 |
| Aetna | NewBusiness | $801 |
| United | AllPayerAppendix | $828 |
| Aetna | COMM | $856 |
| Aetna | Meritain | $856 |
| Superior Health Plan | CHIP | $951 |
| Superior Health Plan | MCDSTAR | $951 |
| Superior Health Plan | STARHealth | $951 |
| Superior Health Plan | STARKids | $951 |
| Superior Health Plan | STARPLUS | $951 |
| Aetna | OON | $1,013 |
| BCBS | BlueEssentials | $1,485 |
| BCBS | BlueEssentialsAccess | $1,485 |
| BCBS | Eposoa | $1,558 |
| BCBS | PPO | $1,631 |
| Cigna | IFP | $1,833 |
| Cigna | QHP | $1,901 |
| United | OptionsPPO | $3,001 |
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All common services at Medical City Surgical Hospital Alliance