CT abdomen and pelvis with contrast at Johnston Memorial Hospital. CPT 74177.
What Johnston Memorial Hospital publishes for this service, straight from its standard-charges file, last updated March 23, 2026.
Outpatient / ER
$560cash price (self-pay)
$3,731list price
$224–$3,731range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Cross | Tenncare Blue Care | $224 |
| Blue Cross | Tenncare Blue Select | $224 |
| Blue Cross | Blue Cross Ballad Health Employee | $237 |
| Aetna | Aetna Healthcare Medicare | $340 |
| Allcare Medicare | Allcare Medicare | $340 |
| Blue Cross | Blue Cross Medicare | $340 |
| Humana | Humana Medicare | $340 |
| Managed Medicaire | Managed Medicaire | $340 |
| Mountain Empire Pace | Mountain Empire Pace | $340 |
| Sentara Health | Sentara Medicare | $340 |
| Aetna | Aetna Better Health Of Virginia Medicare | $351 |
| Blue Cross | Anthem Medicare Virginia | $351 |
| Amerigroup | Amerigroup Medicare Wellpoint | $354 |
| Molina Healthcare | Molina Healthcare Medicare | $354 |
| Cigna Healthcare | Cigna Medicare | $357 |
| Devoted Health Plan | Devoted Health Plan Medicare | $357 |
| Nhc Advantage | Nhc Advantage | $357 |
| Optima Health | Optima Health Medicaid | $408 |
| Blue Cross | Anthem Hlthkeep Mediciad | $420 |
| Molina Healthcare | Molina Healthcare Medicaid | $424 |
| Cigna Healthcare | Cigna Individual Family Plan | $427 |
| Aetna | Aetna Better Health Of Virginia | $428 |
| Amerigroup | Amerigroup | $453 |
| Cigna Healthcare | Cigna HMO | $488 |
| Cigna Healthcare | Cigna Open Access Plus | $488 |
| United Healthcare | Tenncare United Healthcare | $522 |
| Cigna Healthcare | Cigna PPO | $542 |
| Ambetter | Ambetter | $742 |
| Blue Cross | Anthem Exchange | $1,143 |
| Sentara Health | Sentara Health | $1,252 |
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