CT abdomen and pelvis with contrast at St. Luke's Jerome Standard Charges. CPT 74177.
What St. Luke's Jerome 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
$390–$2,150range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Commercial [1028] | Hb Mv Va Ccn | $390 |
| Medicare Advantage Generic [1019] | Hb Mv Medicare Advantage | $390 |
| Medicare Advantage Generic [1019] | Hb Mv Molina Mmcp | $390 |
| Medicare Advantage Molina [1053] | Hb Mv Molina Mmcp | $390 |
| Medicare Advantage Pacificsource [1039] | Hb Mv Pacificsource HMO PPO | $390 |
| Medicare Advantage Pacificsource [1039] | Hb Mv Slhp Pacificsource Med | $390 |
| Medicare Advantage Regence [1016] | Hb Mv Medicare Advantage | $390 |
| Blue Cross/Medicare Advantage [1009] | Hb Mv Bci True & Secure Med Adv | $393 |
| Medicare Advantage Generic [1019] | Hb Mv Molina Med Adv | $397 |
| Medicare Advantage Molina [1053] | Hb Mv Molina Med Adv | $397 |
| Medicare Advantage UHC [1013] | Hb Mv Aarp Optum Ubh Med Adv | $409 |
| Medicare Advantage Aetna [1017] | Hb Mv Aetna Med Adv | $428 |
| Blue Cross Idaho [1007] | Hb Mv Slhp Blue Cross Carepoint Qhp | $582 |
| Commercial [1028] | Hb Mv Slhp Mountain Health Coop | $582 |
| Commercial [1028] | Hb Mv Slhp Select Health Qhp | $582 |
| Slplan Tap Mc St Lukes Health Plan [1641000001] | Hb Mv Slhp St Lukes | $752 |
| Blue Cross Idaho [1007] | Hb Mv Slhp Blue Cross Large Group | $921 |
| Commercial [1028] | Hb Mv Slhp Select Health | $921 |
| Blue Cross Out Of State [1041] | Hb Mv Bci Out Of State | $1,392 |
| Blue Shield Alt [100401] | Hb Mv Regence Out Of State | $1,392 |
| Commercial [1028] | Hb Mv Regence PPO & Traditional | $1,392 |
| Commercial [1028] | Hb Mv H2b | $1,697 |
| H2b [1068] | Hb Mv H2b | $1,697 |
| Blue Cross Federal [1008] | Hb Mv Bci PPO Fep | $1,734 |
| Blue Cross Idaho [1007] | Hb Mv Bci PPO Fep | $1,734 |
| Cigna [1062] | Hb Mv Cigna | $1,810 |
| Commercial [1028] | Hb Mv Cigna | $1,810 |
| Commercial [1028] | Hb Mv Multiplan Primary Network | $1,810 |
| Commercial [1028] | Hb Mv Amps | $1,924 |
| Commercial [1028] | Hb Mv Christian Health Aid | $1,924 |
Inpatient
$3,763cash price (self-pay)
$3,763list price
$2,446–$3,575range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Slplan Tap Mc St Lukes Health Plan [1641000001] | Hb Mv Slhp St Lukes | $2,446 |
| Blue Cross Idaho [1007] | Hb Mv Slhp Blue Cross Carepoint Qhp | $2,446 |
| Blue Cross Idaho [1007] | Hb Mv Slhp Blue Cross Large Group | $2,446 |
| Commercial [1028] | Hb Mv Slhp Mountain Health Coop | $2,446 |
| Commercial [1028] | Hb Mv Slhp Select Health | $2,446 |
| Commercial [1028] | Hb Mv Slhp Select Health Qhp | $2,446 |
| Medicare Advantage Pacificsource [1039] | Hb Mv Slhp Pacificsource Med | $2,446 |
| Mountain Health Co-Op [1067] | Hb Mv Slhp Mountain Health Coop | $2,446 |
| Pacificsource [1020] | Hb Mv Pacificsource Navigator Large Group | $2,446 |
| Pacificsource [1020] | Hb Mv Slhp Pacificsource Navigator Qhp | $2,446 |
| Select Health [1063] | Hb Mv Slhp Select Health | $2,446 |
| Select Health [1063] | Hb Mv Slhp Select Health Qhp | $2,446 |
| St Lukes Health Plan [1046] | Hb Mv Slhp St Lukes Health Plan Large Gr | $2,446 |
| St Lukes Health Plan [1046] | Hb Mv Slhp St Lukes Health Plan Qhp | $2,446 |
| Commercial [1028] | Hb Mv H2b | $2,822 |
| H2b [1068] | Hb Mv H2b | $2,822 |
| Pacificsource [1020] | Hb Mv Pacificsource PPO Voyager | $2,822 |
| Aetna [1021] | Hb Mv Bp Aetna | $3,010 |
| Cigna [1062] | Hb Mv Cigna | $3,010 |
| Commercial [1028] | Hb Mv Bp Aetna | $3,010 |
| Commercial [1028] | Hb Mv Cigna | $3,010 |
| Commercial [1028] | Hb Mv Multiplan Primary Network | $3,010 |
| Commercial [1028] | Hb Mv Va Ccn | $3,010 |
| Providence [1022] | Hb Mv Cigna | $3,010 |
| Commercial [1028] | Hb Mv Amps | $3,199 |
| Commercial [1028] | Hb Mv Christian Health Aid | $3,199 |
| Commercial [1028] | Hb Mv First Choice Health | $3,199 |
| First Health [1064] | Hb Mv First Choice Health | $3,199 |
| Blue Cross Federal [1008] | Hb Mv Bci PPO Fep | $3,217 |
| Blue Cross Idaho [1007] | Hb Mv Bci PPO Fep | $3,217 |
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