CT abdomen and pelvis with contrast at Palo Pinto General Hospital. CPT 74177.
What Palo Pinto General Hospital publishes for this service, straight from its standard-charges file, last updated July 8, 2026.
Outpatient / ER
$803cash price (self-pay)
$1,605list price
$312–$1,043range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| UHC Community Plan | EPO | $312 |
| Aetna Medicare Advantage | HMO | $349 |
| Humana Medicare | HMO | $349 |
| Oscar | PPO | $366 |
| UHC Commercial | PPO | $381 |
| Ambetter Commercial Exchange | POS | $401 |
| Molina Medicaid | EPO | $462 |
| Wellpoint Medicaid | EPO | $462 |
| Baylor Scott and White Commercial | POS | $650 |
| BCBS TX Blue Essentials | HMO | $924 |
| BCBS TX Blue Advantage | PPO | $924 |
| BCBS TX PPO | PPO | $974 |
| Cigna | PPO | $988 |
| Aetna Commercial | PPO | $1,043 |
Inpatient
$803cash price (self-pay)
$1,605list price
$535–$1,605range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| BCBS TX Blue Essentials | HMO | $535 |
| BCBS TX Blue Advantage | PPO | $535 |
| BCBS TX PPO | PPO | $562 |
| Molina Medicaid | EPO | $1,140 |
| Wellpoint Medicaid | EPO | $1,140 |
| UHC Community Plan | EPO | $1,140 |
| Oscar | PPO | $1,605 |
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