CT abdomen and pelvis with contrast at Northwest Texas Healthcare System Behavioral Health. CPT 74177.
What Northwest Texas Healthcare System Behavioral Health publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
—cash price (self-pay)
$21,638list price
$201–$17,310range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Oklahoma | Medicaid | $201 |
| Superior | Medicaid | $312 |
| Molina | Medicaid | $328 |
| First_care_chip | Medicaid | $343 |
| Wellpoint_starkids | Medicaid | $858 |
| Superior_starkids | Medicaid | $944 |
| Amerigroup | Medicaid | $946 |
| First_care_star | Medicaid | $1,040 |
| Superior_star | Medicaid | $1,040 |
| Superior_star_plus | Medicaid | $1,114 |
| Wellpoint_ Amgrp_star_plus | Medicaid | $1,114 |
| First_care_star_plus | Medicaid | $1,226 |
| Blue_cross_blue_shield_of_tx | Advantage | $1,310 |
| Blue_cross_blue_shield_of_tx | HMO | $1,428 |
| Blue_cross_blue_shield_of_tx | Managed_care | $1,535 |
| Blue_cross_blue_shield_of_tx | PPO | $1,589 |
| Aetna | Managed_care | $4,328 |
| Scott_and_white_healthplan | Managed_care | $5,842 |
| Cigna | Managed_care | $7,184 |
| Multiplan | Managed_care | $17,310 |
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All common services at Northwest Texas Healthcare System Behavioral Health