CT abdomen and pelvis with contrast at Wj Mangold Memorial Hospital. CPT 74177.
What Wj Mangold Memorial Hospital publishes for this service, straight from its standard-charges file, last updated September 15, 2026.
Outpatient / ER
$1,814cash price (self-pay)
$1,814list price
$462–$1,402range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Amerigroup | CHIP | $462 |
| Amerigroup | Medicaid | $462 |
| FirstCare | CHIP | $462 |
| FirstCare | Medicaid | $462 |
| United HealthCare | Commercial | $550 |
| Amerigroup | Medicare Advantage | $744 |
| FirstCare | Medicare | $744 |
| Humana | Medicare Advantage | $744 |
| United HealthCare | Mediare Advantage | $744 |
| TriCare | TriCare | $766 |
| FirstCare | Commercial | $1,237 |
| FirstCare | PPO | $1,237 |
| Blue Cross Blue Shield | Commercial | $1,319 |
| Cigna HealthCare | Commercial | $1,319 |
| TeamChoice | PPO | $1,319 |
| Aetna Health Inc. | Commercial | $1,402 |
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