CT abdomen and pelvis with contrast at Methodist Stone Oak Rehabilitation Hospital. CPT 74177.
What Methodist Stone Oak Rehabilitation Hospital publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$14,859cash price (self-pay)
$14,859list price
$312–$12,630range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| United | MCD | $312 |
| Community First Health Plans | CHIP | $312 |
| Community First Health Plans | CHIPPerinate | $312 |
| Community First Health Plans | MCDSTAR | $312 |
| USA Managed Care CHIP | CHIP | $312 |
| Amerigroup | CHIP | $318 |
| Amerigroup | MCD | $318 |
| Community First Health Plans | MCDSTARKIDS | $318 |
| Community First Health Plans | STARPLUS | $318 |
| Molina Healthcare | CHIP | $343 |
| Molina Healthcare | MCDSTAR | $343 |
| Molina Healthcare | STAR+PLUS | $343 |
| Molina Healthcare | STARKIDS | $343 |
| Aetna Better Health | CHIP | $344 |
| Aetna Better Health | CHIPEPO | $344 |
| Aetna Better Health | CHIPPerinate | $344 |
| Aetna Better Health | CHPFC | $344 |
| Aetna Better Health | STAR | $344 |
| Aetna Better Health | STAR+PLUS | $344 |
| Aetna Better Health | STARKids | $344 |
| Humana | MGMCD | $390 |
| BCBS | MyBlueHealth | $615 |
| Aetna | NarrowNetwork | $778 |
| United | AllPayerAppendix | $828 |
| United | Charter | $828 |
| United | NexusACO | $828 |
| United | SmallGroup | $828 |
| BCBS | BlueAdvantage | $882 |
| Aetna | NewBusinessRates | $926 |
| Aetna | CommercialBaseNetwork | $944 |
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All common services at Methodist Stone Oak Rehabilitation Hospital