CT scan of abdomen and pelvis without contrast
| 2020 CPT/HCPCS | 74176 |
| Negotiated Private Fee | $450.00 |
| Prossam | $450.00 |
| Champva | $201.68 |
| First Medical | $275.00 |
| First Medical Vital | $142.97 |
| Plan de Salud Menonita | $300.00 |
| Menonita Vital | $164.32 |
| Humana Gold plus/ Gold choice | Ambulatory Payment classification (APC) |
| Humana | $412.50 |
| Mapfre | $400.00 |
| Mcs Classicare | $252.00 |
| MCS Life | $285.00 |
| Medicare | Ambulatory Payment classification (APC) |
| MMM | $183.82 |
| MMM Vital | $143.78 |
| Panamerican Life | Not covered |
| PMC | $183.82 |
| Tricare | $196.88 |
| Triple S Salud | $450.00 |
| Triple S Vital | $217.43 |
| Triple S Advantage | Ambulatory Payment classification (APC) |
| Negotiated Minimum Charge | $142.97 |
| Negotiated Maximus Charge | $450.00 |
| Discounted Cash Price | $360.00 |
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