CPT 74177

CT Abdomen and Pelvis With Contrast

CPT 74177 is one of the most commonly ordered diagnostic CT scans, used for abdominal pain, cancer staging, and evaluating kidney stones (though 74176 without contrast is preferred for stones). Medicare pays $300.27 for this scan, but providers charge an average of $1,049.94 (a 3.5x markup). In the ER, this scan is often the single most expensive line item after the facility fee. Freestanding imaging centers offer this scan for $400 to $800, compared to $1,500 to $3,000 at hospitals.

Updated May 2026Source: CMS Physician Fee Schedule

CPT 74177 at a Glance

Average provider charge: $1,049.94
Medicare rate: $300.27
Typical markup: 3.5x over Medicare
Freestanding center range: $400 to $800

Setting: Same rate office and facility
Common uses: Abdominal pain, cancer staging, kidney stones
Outpatient beneficiaries: 454,943
Components: Technical (TC) + Professional (26)

How the Medicare Rate Is Calculated

Medicare prices every procedure using Relative Value Units (RVUs) across three components, then multiplies by a national conversion factor of $33.4009 (2026). For imaging codes like 74177, the non-facility and facility Practice Expense RVUs are identical, so Medicare pays the same rate regardless of setting. However, hospitals add their own facility fee on top, which is why hospital imaging costs significantly more.

Component	What It Covers	RVU
Work RVU	Radiologist time, skill, and judgment	1.77
Practice Expense RVU	CT equipment, technologist, contrast material, supplies	7.09
Malpractice RVU	Professional liability insurance	0.13
Total RVU		8.99
x $33.4009	2026 conversion factor	$300.27

Technical vs. professional component: Imaging bills often arrive as two separate charges. The technical component (modifier -TC) covers the CT equipment and technologist. The professional component (modifier -26) covers the radiologist's interpretation. When billed "globally" with no modifier, both are included. Always ask whether a quoted price includes the radiologist reading fee.

Medicare Rate by State

Medicare adjusts the national rate using Geographic Practice Cost Indices (GPCIs). The same abdominal CT pays differently depending on your location.

Medicare Rate by State (2026)

Medicare adjusts payments by location using Geographic Practice Cost Indices (GPCIs). Select your state to see the adjusted rate.

Sample State Rates

State	Medicare Pays	Avg. Charge	Markup
Texas (Austin)	$306.24	$1,049.94	3.4x
California (Los Angeles)	$335.87	$1,049.94	3.1x
New York (Manhattan)	$338.41	$1,049.94	3.1x
Florida (Fort Lauderdale)	$312.81	$1,049.94	3.4x
Ohio	$279.36	$1,049.94	3.8x
Mississippi	$268.67	$1,049.94	3.9x
Arkansas	$266.45	$1,049.94	3.9x
Alaska	$371.67	$1,049.94	2.8x

Rates shown use 2026 GPCIs and the $33.4009 conversion factor. For imaging codes, the Medicare physician fee is the same in office and facility settings. The average provider charge of $1,049.94 is the 2023 national average from CMS utilization data.

What Insured Patients Actually Pay for an Abdominal CT

Your insurer has a negotiated rate with the imaging facility, typically 150% to 300% of the Medicare rate. For a CT abdomen/pelvis with contrast, that negotiated rate is usually $450 to $900. What you owe depends on your plan:

Your Situation	What You Likely Pay	How It Works
Copay plan (deductible met)	$100 to $250	Flat copay for advanced imaging
Coinsurance plan (deductible met)	$90 to $180	20% of the negotiated rate ($450 to $900)
High-deductible plan (deductible NOT met)	$450 to $900	Full negotiated rate until deductible is met
Medicare Part B	$60.05	20% of $300.27 after annual deductible

Watch for the facility fee: The amounts above cover the scan itself. If your CT is done at a hospital outpatient department (including the ER), expect a separate facility fee of $500 to $1,500. This facility fee is subject to its own cost sharing. At a freestanding imaging center, there is no separate facility fee.

Should You Use Insurance or Pay Cash?

If you have a high-deductible health plan and have not met your deductible, you are paying the full negotiated rate for imaging. For a CT abdomen/pelvis with contrast, this is typically $450 to $900 through insurance. Freestanding imaging centers often offer cash-pay rates of $400 to $800 for this scan.

When Cash-Pay Wins

The freestanding center's cash rate is close to or below your insurer's negotiated rate
You are unlikely to meet your deductible this year
You need the scan quickly and the cash-pay center has shorter wait times
Your insurance requires prior authorization that is delaying the scan

When Using Insurance Wins

You are close to meeting your annual deductible
Your plan has a reasonable imaging copay
You expect more medical expenses later this year
The scan needs to be documented in your insurance records for follow-up care or cancer staging

Important: Cash payments do not count toward your insurance deductible or out-of-pocket maximum. If you pay cash for this CT and later need additional imaging or treatment, those cash payments will not have moved you closer to your deductible threshold.

Common Billing Problems with Abdominal CT Scans

ER facility fees that dwarf the scan cost

When a CT abdomen/pelvis is done in the emergency room, the ER facility fee ($500 to $1,500) can rival the cost of the scan itself. The abdominal CT is often the single most expensive item on an ER bill after the facility fee. If your condition was not a true emergency, getting the scan at a freestanding imaging center on an outpatient basis could save you $1,000 or more.

Wrong contrast code: 74176 vs 74177 vs 74178

CPT 74176 is the abdomen/pelvis CT without contrast. CPT 74177 is with contrast. CPT 74178 includes both with and without contrast sequences and costs even more. Verify that the code on your bill matches the scan you actually received. If you did not receive contrast material (an IV injection during the scan), you should be billed under 74176, not 74177. Also ask your doctor if the non-contrast version (74176) would have been sufficient for your condition, especially for kidney stones.

Separate bills for technical and professional components

You may receive two bills for one CT: one from the facility (technical component, modifier -TC) and one from the radiologist (professional component, modifier -26). This is normal for hospital-based imaging but can be confusing. Together, these two bills should roughly equal the global rate. If the combined total significantly exceeds the global rate, question the charges.

Missing prior authorization

Most insurance plans require prior authorization for CT scans. If your provider did not obtain authorization before the scan, your insurer may deny the claim and leave you with the full bill. ER scans are generally exempt from prior authorization requirements. If your outpatient CT claim was denied for lack of authorization, ask your provider to submit a retroactive authorization request.

Related Imaging Codes

Code	Description	Medicare Rate
74176	CT abdomen and pelvis without contrast	Lower
74177	CT abdomen and pelvis with contrast	$300.27
74178	CT abdomen and pelvis with and without contrast	Higher

Frequently Asked Questions

How much does a CT scan of the abdomen and pelvis cost without insurance?

Without insurance, a CT abdomen and pelvis with contrast (CPT 74177) costs $400 to $3,000 depending on the facility. The national average provider charge is $1,049.94. Freestanding imaging centers typically charge $400 to $800, while hospital outpatient departments charge $1,500 to $3,000 or more. Medicare pays $300.27 for this scan.

What is the difference between CPT 74176, 74177, and 74178?

CPT 74176 is a CT abdomen and pelvis without contrast. CPT 74177 is with contrast. CPT 74178 includes both with and without contrast sequences. The non-contrast version (74176) is preferred for kidney stones and is cheaper. The with-and-without version (74178) is typically used for cancer staging. Ask your doctor if the non-contrast version would be sufficient for your condition.

Why is my ER CT scan bill so expensive?

When a CT abdomen/pelvis is done in the ER, the scan itself is often the single most expensive line item after the ER facility fee. The hospital charges its own rate (often $1,500 to $3,000) plus a separate facility fee. If your condition is not a true emergency, getting the CT at a freestanding imaging center on an outpatient basis can save you $1,000 or more.

Does insurance require prior authorization for an abdominal CT?

Most insurance plans require prior authorization for CT scans. ER scans are typically exempt from prior authorization requirements. For outpatient scans, your doctor handles the authorization, but delays can occur. If you have a high-deductible plan, compare the cash price at a freestanding center against your insurer's negotiated rate. Cash may be cheaper but will not count toward your deductible.

Need Help Lowering a Medical Bill?

CareRoute Bill Defense is a done-for-you bill reduction service. We analyze the codes on your imaging bill, identify overcharges and coding errors, and apply reduction strategies on your behalf. If your abdominal CT bill seems too high, we can help.

Learn about Bill Defense