CT abdomen and pelvis with contrast at St. Luke's Boise Standard Charges. CPT 74177.
What St. Luke's Boise Standard Charges publishes for this service, straight from its standard-charges file, last updated March 25, 2026.
Outpatient / ER
$2,263cash price (self-pay)
$2,263list price
$377–$2,037range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Commercial [1028] | Hb Tv Va Ccn | $377 |
| Medicare Advantage Generic [1019] | Hb Tv Medicare Advantage | $377 |
| Medicare Advantage Generic [1019] | Hb Tv Molina Mmcp | $377 |
| Medicare Advantage Molina [1053] | Hb Tv Molina Mmcp | $377 |
| Medicare Advantage Pacificsource [1039] | Hb Tv Pacificsource HMO PPO | $377 |
| Medicare Advantage Pacificsource [1039] | Hb Tv Slhp Pacificsource Med | $377 |
| Medicare Advantage Regence [1016] | Hb Tv Medicare Advantage | $377 |
| Blue Cross/Medicare Advantage [1009] | Hb Tv Bci True & Secure Med Adv | $380 |
| Medicare Advantage Generic [1019] | Hb Tv Molina Med Adv | $384 |
| Medicare Advantage Molina [1053] | Hb Tv Molina Med Adv | $384 |
| Medicare Advantage UHC [1013] | Hb Tv Aarp Med Adv | $396 |
| Medicare Advantage Aetna [1017] | Hb Tv Aetna Med Adv | $414 |
| Blue Cross Idaho [1007] | Hb Tv Slhp Blue Cross Carepoint Qhp | $582 |
| Commercial [1028] | Hb Tv Slhp Mountain Health Coop | $582 |
| Commercial [1028] | Hb Tv Slhp Select Health Qhp | $582 |
| Slplan Tap Mc St Lukes Health Plan [1641000001] | Hb Tv Slhp St Lukes | $752 |
| Blue Cross Idaho [1007] | Hb Tv Slhp Blue Cross Large Group | $921 |
| Commercial [1028] | Hb Tv Slhp Select Health | $921 |
| Blue Cross Out Of State [1041] | Hb Tv Bci Out Of State | $1,392 |
| Blue Shield Alt [100401] | Hb Tv Regence Out Of State | $1,392 |
| Commercial [1028] | Hb Tv Regence PPO & Traditional | $1,392 |
| Commercial [1028] | Hb Tv H2b | $1,697 |
| H2b [1068] | Hb Tv H2b | $1,697 |
| Blue Cross Federal [1008] | Hb Tv Bci PPO Fep | $1,734 |
| Blue Cross Idaho [1007] | Hb Tv Bci PPO Fep | $1,734 |
| Cigna [1062] | Hb Tv Cigna | $1,810 |
| Commercial [1028] | Hb Tv Cigna | $1,810 |
| Commercial [1028] | Hb Tv Multiplan Primary Network | $1,810 |
| Commercial [1028] | Hb Tv United Healthcare | $1,856 |
| Geha [1065] | Hb Tv United Healthcare | $1,856 |
Inpatient
$3,763cash price (self-pay)
$3,763list price
$2,446–$3,387range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Slplan Tap Mc St Lukes Health Plan [1641000001] | Hb Tv Slhp St Lukes | $2,446 |
| Blue Cross Idaho [1007] | Hb Tv Slhp Blue Cross Carepoint Qhp | $2,446 |
| Blue Cross Idaho [1007] | Hb Tv Slhp Blue Cross Large Group | $2,446 |
| Commercial [1028] | Hb Tv Slhp Mountain Health Coop | $2,446 |
| Commercial [1028] | Hb Tv Slhp Select Health | $2,446 |
| Commercial [1028] | Hb Tv Slhp Select Health Qhp | $2,446 |
| Medicare Advantage Pacificsource [1039] | Hb Tv Slhp Pacificsource Med | $2,446 |
| Mountain Health Co-Op [1067] | Hb Tv Slhp Mountain Health Coop | $2,446 |
| Pacificsource [1020] | Hb Tv Pacificsource Navigator Large Group | $2,446 |
| Pacificsource [1020] | Hb Tv Slhp Pacificsource Navigator Qhp | $2,446 |
| Select Health [1063] | Hb Tv Slhp Select Health | $2,446 |
| Select Health [1063] | Hb Tv Slhp Select Health Qhp | $2,446 |
| St Lukes Health Plan [1046] | Hb Tv Slhp St Lukes Health Plan Large Gr | $2,446 |
| St Lukes Health Plan [1046] | Hb Tv Slhp St Lukes Health Plan Qhp | $2,446 |
| Commercial [1028] | Hb Tv H2b | $2,822 |
| H2b [1068] | Hb Tv H2b | $2,822 |
| Pacificsource [1020] | Hb Tv Pacificsource PPO Voyager | $2,822 |
| Aetna [1021] | Hb Tv Bp Aetna | $3,010 |
| Cigna [1062] | Hb Tv Cigna | $3,010 |
| Commercial [1028] | Hb Tv Bp Aetna | $3,010 |
| Commercial [1028] | Hb Tv Cigna | $3,010 |
| Commercial [1028] | Hb Tv Multiplan Primary Network | $3,010 |
| Commercial [1028] | Hb Tv Va Ccn | $3,010 |
| Providence [1022] | Hb Tv Cigna | $3,010 |
| Commercial [1028] | Hb Tv United Healthcare | $3,086 |
| Geha [1065] | Hb Tv United Healthcare | $3,086 |
| United Healthcare [1025] | Hb Tv United Healthcare | $3,086 |
| United Medical Resources [1051] | Hb Tv United Healthcare | $3,086 |
| Commercial [1028] | Hb Tv Ccn First Health | $3,104 |
| First Health [1064] | Hb Tv Ccn First Health | $3,104 |
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