CT abdomen and pelvis with contrast at Memorial Medical Center. CPT 74177.
What Memorial Medical Center publishes for this service, straight from its standard-charges file, last updated September 14, 2026.
Outpatient / ER
$3,495cash price (self-pay)
$4,993list price
$1,108–$4,244range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Cross HMO | Blue Cross HMO | $1,108 |
| Blue Cross Options | Blue Cross Options | $1,108 |
| Blue Cross Trad-All Other Plans | Blue Cross Trad-All Other Plans | $1,202 |
| Blue Cross PPO | Blue Cross PPO | $1,202 |
| Triwest Va Pccc-All Plans | Triwest Va Pccc-All Plans | $1,566 |
| Care Improvement Plus - All Other Plans | Care Improvement Plus - All | $1,598 |
| Coventry First Hlth Mcr Adv | Coventry First Hlth Mcr Adv | $1,598 |
| Superior Allwell Mcr Adv-All Other Plans | Superior Allwell Mcr Adv-Al | $1,598 |
| UHC Mcr Adv | UHC Mcr Adv | $1,598 |
| Amerigroup Mcr Adv-All Other Plans | Amerigroup Mcr Adv-All Other Plan | $1,598 |
| Multiplan Mcr Adv | Multiplan Mcr Adv | $1,598 |
| Care Improvement Plus Mcr | Care Improvement Plus Mcr | $1,614 |
| Universal American Snp | Universal American Snp | $1,678 |
| Superior Hp Ambetter | Superior Hp Ambetter | $1,917 |
| Amerigroup Chip | Amerigroup Chip | $2,826 |
| Amerigroup Star | Amerigroup Star | $2,826 |
| Amerigroup Star Kids | Amerigroup Star Kids | $2,826 |
| Amerigroup Star Plus | Amerigroup Star Plus | $2,826 |
| Comm Health Chip | Comm Health Chip | $2,826 |
| Comm Health Perinatal-All Other Plans | Comm Health Perinatal-All Othe | $2,826 |
| Molina Chip/Star-All Plans | Molina Chip/Star-All Plans | $2,826 |
| Texas Childrens Hp - All Plans | Texas Childrens Hp - All Plans | $2,826 |
| UHC Star Plus | UHC Star Plus | $2,826 |
| Scott & White Chip/Star-All Plans | Scott & White Chip/Star-All Plans | $2,826 |
| Superior Chip/Star | Superior Chip/Star | $2,826 |
| Comm Health Mcaid HMO | Comm Health Mcaid HMO | $2,967 |
| Comm Health Star | Comm Health Star | $2,967 |
| Prime Healthcare Services-All Plans | Prime Healthcare Services-All Pl | $3,495 |
| Cigna-All Plans | Cigna-All Plans | $3,745 |
| Humana Tricare-All Plans | Humana Tricare-All Plans | $3,994 |
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