CT abdomen and pelvis with contrast at Texoma Medical Center Behavioral Health Center. CPT 74177.
What Texoma Medical Center Behavioral Health Center publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$16,889cash price (self-pay)
$24,431list price
$274–$19,757range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Oklahoma | Medicaid | $274 |
| Superior | Medicaid | $318 |
| Molina | Medicaid | $328 |
| Tchp Star | Medicaid | $328 |
| UHC Star Plus | Medicaid | $655 |
| Wellpt Amgrp Str Pls | Medicaid | $655 |
| Superior Hlth Str Pls | Medicaid | $668 |
| Molina Star Plus | Medicaid | $688 |
| Healthchoice | Managed_care | $714 |
| Wellpoint Starkids | Medicaid | $727 |
| Amerigroup | Medicaid | $1,099 |
| UHC Star | Medicaid | $1,099 |
| Superior Star | Medicaid | $1,120 |
| Tchp | Medicaid | $1,153 |
| Blue_cross_blue_shield_of_tx | Qhp | $1,214 |
| Blue_cross_blue_shield_of_tx | HMO | $1,405 |
| Blue_cross_blue_shield_of_tx | PPO | $1,562 |
| Aetna | Managed_care | $6,230 |
| Coventry_healthfirst | Managed_care | $6,352 |
| Multiplan | Managed_care | $13,022 |
| Humana | Managed_care | $14,243 |
| Healthsmart | Managed_care | $18,323 |
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All common services at Texoma Medical Center Behavioral Health Center