CT abdomen and pelvis with contrast at Teton Valley Health Care. CPT 74177.
What Teton Valley Health Care publishes for this service, straight from its standard-charges file, last updated July 21, 2026.
Outpatient / ER
$2,300cash price (self-pay)
$2,875list price
$75.88–$2,818range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Cross Medicaid | Blue Cross Medicaid | $75.88 |
| UHC Medicare Advantage | UHC Medicare Advantage | $1,323 |
| Aetna Medicare | Aetna Medicare | $1,351 |
| Prime Health Services-All Other Plans | Prime Health Services-All Othe | $1,351 |
| Humana-All Plans | Humana-All Plans | $1,351 |
| Prime Health Medicare Advantage | Prime Health Medicare Advantage | $1,351 |
| Regence Blue Shield Medicare Advantage | Regence Blue Shield Medicare | $1,351 |
| Select Health Medicare Advantage | Select Health Medicare Advantage | $1,351 |
| Triwest-All Plans | Triwest-All Plans | $1,351 |
| Blue Cross Mcr Adv | Blue Cross Mcr Adv | $1,365 |
| First Choice-All Plans | First Choice-All Plans | $2,588 |
| Moda-All Plans | Moda-All Plans | $2,588 |
| Blue Cross Qhp | Blue Cross Qhp | $2,649 |
| Aetna-All Other Plans | Aetna-All Other Plans | $2,674 |
| Select Health-All Other Plans | Select Health-All Other Plans | $2,731 |
| UHC All Payer-All Other Plans | UHC All Payer-All Other Plans | $2,731 |
| Cigna Oap | Cigna Oap | $2,731 |
| Cigna PPO-All Other Plans | Cigna PPO-All Other Plans | $2,731 |
| St Lukes Brightpath-All Plans | St Lukes Brightpath-All Plans | $2,731 |
| Blue Cross Trad/PPO/POS-All Other Plans | Blue Cross Trad/PPO/POS-All | $2,789 |
| Regence Blue Shield-All Other Plans | Regence Blue Shield-All Other Pl | $2,818 |
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