CT abdomen and pelvis with contrast at St. Luke's Wood River Standard Charges. CPT 74177.
What St. Luke's Wood River 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
$1,290–$2,195range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Commercial [1028] | Hb Wr Va Ccn | $1,290 |
| Medicare Advantage Generic [1019] | Hb Wr Medicare Advantage | $1,290 |
| Medicare Advantage Generic [1019] | Hb Wr Molina Mmcp | $1,290 |
| Medicare Advantage Molina [1053] | Hb Wr Molina Mmcp | $1,290 |
| Medicare Advantage Pacificsource [1039] | Hb Wr Pacificsource HMO PPO | $1,290 |
| Medicare Advantage Pacificsource [1039] | Hb Wr Slhp Pacificsource Med | $1,290 |
| Medicare Advantage Regence [1016] | Hb Wr Medicare Advantage | $1,290 |
| Veterans Affairs [1056] | Hb Wr Va Ccn | $1,290 |
| Blue Cross/Medicare Advantage [1009] | Hb Wr Bci True & Secure Med Adv | $1,303 |
| Medicare Advantage Generic [1019] | Hb Wr Molina Med Adv | $1,316 |
| Medicare Advantage Molina [1053] | Hb Wr Molina Med Adv | $1,316 |
| Medicare Advantage UHC [1013] | Hb Wr Aarp Med Adv | $1,354 |
| Medicare Advantage Aetna [1017] | Hb Wr Aetna Med Adv | $1,419 |
| Blue Cross Federal [1008] | Hb Wr Bci PPO Fep | $1,734 |
| Blue Cross Idaho [1007] | Hb Wr Bci PPO Fep | $1,734 |
| Blue Cross Out Of State [1041] | Hb Wr Bci PPO Fep | $1,734 |
| Commercial [1028] | Hb Wr Multiplan Primary Network | $1,810 |
| Commercial [1028] | Hb Wr Amps | $1,924 |
| Commercial [1028] | Hb Wr Christian Health Aid | $1,924 |
| Commercial [1028] | Hb Wr Moda Commercial | $1,991 |
| Moda [1055] | Hb Wr Moda Commercial | $1,991 |
| Aetna [1021] | Hb Wr Aetna Trinity Health (St Al'S) | $2,037 |
| Commercial [1028] | Hb Wr Northern Nevada Laborers Trust | $2,037 |
| Commercial [1028] | Hb Wr United Healthcare | $2,048 |
| Geha [1065] | Hb Wr United Healthcare | $2,048 |
| United Health Care [1025] | Hb Wr United Healthcare | $2,048 |
| United Medical Resources [1051] | Hb Wr United Healthcare | $2,048 |
| Cigna [1062] | Hb Wr Cigna | $2,105 |
| Commercial [1028] | Hb Wr Cigna | $2,105 |
| Providence [1022] | Hb Wr Cigna | $2,105 |
Inpatient
$3,763cash price (self-pay)
$3,763list price
$2,145–$3,650range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Commercial [1028] | Hb Wr Va Ccn | $2,145 |
| Medicare Advantage Generic [1019] | Hb Wr Medicare Advantage | $2,145 |
| Medicare Advantage Generic [1019] | Hb Wr Molina Mmcp | $2,145 |
| Medicare Advantage Molina [1053] | Hb Wr Molina Mmcp | $2,145 |
| Medicare Advantage Pacificsource [1039] | Hb Wr Pacificsource HMO PPO | $2,145 |
| Medicare Advantage Pacificsource [1039] | Hb Wr Slhp Pacificsource Med | $2,145 |
| Medicare Advantage Regence [1016] | Hb Wr Medicare Advantage | $2,145 |
| Veterans Affairs [1056] | Hb Wr Va Ccn | $2,145 |
| Blue Cross/Medicare Advantage [1009] | Hb Wr Bci True & Secure Med Adv | $2,166 |
| Medicare Advantage Generic [1019] | Hb Wr Molina Med Adv | $2,188 |
| Medicare Advantage Molina [1053] | Hb Wr Molina Med Adv | $2,188 |
| Medicare Advantage UHC [1013] | Hb Wr Aarp Med Adv | $2,252 |
| Medicare Advantage Aetna [1017] | Hb Wr Aetna Med Adv | $2,359 |
| Commercial [1028] | Hb Wr Multiplan Primary Network | $3,010 |
| Commercial [1028] | Hb Wr Amps | $3,199 |
| Commercial [1028] | Hb Wr Christian Health Aid | $3,199 |
| Blue Cross Federal [1008] | Hb Wr Bci PPO Fep | $3,217 |
| Blue Cross Idaho [1007] | Hb Wr Bci PPO Fep | $3,217 |
| Blue Cross Out Of State [1041] | Hb Wr Bci PPO Fep | $3,217 |
| Commercial [1028] | Hb Wr Moda Commercial | $3,311 |
| Moda [1055] | Hb Wr Moda Commercial | $3,311 |
| Aetna [1021] | Hb Wr Aetna Trinity Health (St Al'S) | $3,387 |
| Commercial [1028] | Hb Wr Northern Nevada Laborers Trust | $3,387 |
| Commercial [1028] | Hb Wr United Healthcare | $3,406 |
| Geha [1065] | Hb Wr United Healthcare | $3,406 |
| United Health Care [1025] | Hb Wr United Healthcare | $3,406 |
| United Medical Resources [1051] | Hb Wr United Healthcare | $3,406 |
| Cigna [1062] | Hb Wr Cigna | $3,500 |
| Commercial [1028] | Hb Wr Cigna | $3,500 |
| Providence [1022] | Hb Wr Cigna | $3,500 |
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All common services at St. Luke's Wood River Standard Charges