CT abdomen and pelvis with contrast at Alta Vista Regional Hospital. CPT 74177.
What Alta Vista Regional Hospital publishes for this service, straight from its standard-charges file, last updated April 16, 2026.
Outpatient / ER
$4,904cash price (self-pay)
$9,808list price
$288–$9,808range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Commercial HMO PPO | Western Sky Ambetter | $288 |
| Medicaid HMO | Molina Of TX Mcd | $308 |
| Medicaid Ffs | Az Ffs Medicaid | $308 |
| Medicaid Ffs | Colorado Ffs Medicaid | $308 |
| Medicaid Ffs | Ia Ffs Medicaid | $308 |
| Medicaid Ffs | Wy Ffs Medicaid | $308 |
| Php Centennial | Php Centennial | $308 |
| Medicaid HMO | Turquoise BCBS Mcd | $373 |
| Medicaid HMO | Turquoise Molina Mcd | $373 |
| Medicaid HMO | Turquoise Presb Mcd | $373 |
| Medicaid HMO | Turquoise UHC Mcd | $373 |
| Medicaid HMO | Turquoise Care Mcd | $373 |
| Medicaid Ffs | Medicaid Consultec | $373 |
| Medicaid Ffs | Nm Ffs Medicaid | $373 |
| Commercial HMO PPO | Pres Ind Sel | $373 |
| Commercial HMO PPO | Presby Ind Sel | $373 |
| Medicare HMO | Aetna Medicare Advantage | $1,373 |
| UHC Advantage | UHC Advantage | $1,373 |
| Medicare HMO | BCBS Medicare | $1,414 |
| Medicare | Medicare | $1,569 |
| Medicare HMO | Molina Medicare Advantage | $1,569 |
| Misc Medicare Advantage | Misc Medicare Advantage | $1,569 |
| Medicare HMO | Humana Mcr PPO | $1,569 |
| Champus | Triwest | $1,569 |
| Medicare HMO | Aarp UHC Life1 | $1,569 |
| Medicare HMO | Cigna Medicare Advantage | $1,569 |
| Medicare HMO | Presby Medicare Adv | $1,569 |
| Workers Comp | Workers Comp | $4,021 |
| Self Pay | Self Pay | $4,904 |
| Other Covernment | Nm Behavioral Hlth | $6,130 |
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