CT abdomen and pelvis with contrast at Lewisgale Hospital-montgomery. CPT 74177.
What Lewisgale Hospital-montgomery publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$7,056cash price (self-pay)
$7,056list price
$356–$6,350range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| United | AllPayerAppendix | $828 |
| Anthem | HIX | $962 |
| Anthem | HMO | $1,068 |
| Anthem | PPO | $1,068 |
| Cigna | NPR | $1,228 |
| Lifeworks | MCR | $1,341 |
| Universal Healthcare Group | MCR | $1,552 |
| Virginia Health Network | ULTRA | $2,470 |
| United | OptionsPPO | $2,731 |
| Aetna | SharedSavings | $2,919 |
| United | GlobalBenefitPlan | $3,175 |
| Greenvbrier Sporting Club | COMM | $4,234 |
| Aetna | Broad | $4,530 |
| Multiplan | PHCS | $4,728 |
| Virginia Health Network | COMM | $5,010 |
| Virginia Health Network | WC | $5,010 |
| CorVel | WorkersComp | $5,080 |
| Richfield Nursing Center | COMM | $5,292 |
| Richfield Retirement Community | COMM | $5,292 |
| Community Care Network | COMM | $5,645 |
| Graham-White Manufacturing | COMM | $5,645 |
| OccuNet Workers Comp | WorkersComp | $5,645 |
| One Health Plan | POS | $5,645 |
| One Health Plan | PPO | $5,645 |
| Phcs | Comm | $5,998 |
| Patients Choice | COMM | $6,209 |
| 4Most | COMM | $6,350 |
| American Postal Workers Union | COMM | $6,350 |
| Star Transportation | COMM | $6,350 |
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