CPT 74178
CT of the abdomen and pelvis, without and with contrast
A combined CT of the abdomen and pelvis done first without contrast and then with it, in one session. It is a single code, priced higher than either of the single-phase scans, and it exists so that the two phases are not billed as two scans.
Billed to Medicare
$543
What providers submitted, on average, for this code in a hospital setting.
Medicare accepted
$93
What Medicare treated as payable. Not a commercial rate or a cash price.
The gap
5.9x
How many times the accepted amount the billed figure was.
National averages from the Centers for Medicare & Medicaid Services, 2024 data, retrieved 2026-09-14. Medicare fee-for-service, physician and practitioner claims only. The hospital's own charge for the same code is separate and is usually higher. Based on 267,764 services.
Among the 8 imaging codes on this site with CMS figures, this gap ranks 3 of 8 (median 5.5x). The widest is CT scan of the head, without contrast at 6x.
Where this line goes wrong
Not two scans
The billing error to look for is 74176 (without contrast) and 74177 (with contrast) appearing together on the same date. That pair should have been a single 74178.
Was the two-phase scan necessary?
Some indications need both phases; many do not. The radiology order and report will say why both were done.
Check it, then ask
- 1
Ask for the itemized bill and the imaging report, and check that each billed study has a report.
- 2
Check the two halves match: the facility line and the radiologist's line should carry the same code for the same date.
- 3
If the radiologist was out of network for an emergency visit or at an in-network facility, the No Surprises Act limits what you can be billed.
- 4
If you are self-pay, ask for the hospital's published cash price for the scan; it is usually a fraction of the list price.
The full walkthrough for this kind of bill: You got an ER bill.
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People also ask
What is the difference between 74177 and 74178?
74177 is one scan with contrast. 74178 is a scan without contrast followed by a scan with contrast, billed as one combined study.
Sources
This page explains a billing code in general terms. It is not a coding, legal or medical opinion about your bill, and the code descriptions are mediloop's own plain-English summaries, not the official CPT descriptors, which are owned by the American Medical Association. Whether a charge was correct depends on the record of your visit and your payer's rules.