CT abdomen and pelvis with contrast at St. Peters Health Partners. CPT 74177.
What St. Peters Health Partners publishes for this service, straight from its standard-charges file, last updated March 31, 2026.
Outpatient / ER
$188cash price (self-pay)
$188list price
$54.95–$4,322range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Mvp Medicaid Advantage | Mvp Medicaid | $65.41 |
| Mvp Medicaid Advantage | Mvp Medicaid Ess 3 & 4 | $65.41 |
| Nascentia Health Options | Vna Homecare Options | $109 |
| Fidelis Care Medicaid Advantage | Fidelis Medicaid Epp 3 & 4 | $147 |
| Fidelis Care Medicaid Advantage | Fidelis Medicaid Epp 1 & 2 Qhp | $147 |
| Mvp Medicaid Advantage | Mvp Medicaid Ess 1 & 2 | $147 |
| Capital District Physicians Health Medicaid Advantage | Cdphp Medicaid | $245 |
| Blue Cross - NY (Anthem) Medicaid Advantage | Empire Medicaid Essentia | $245 |
| Blue Cross - NY (Excellus) Medicaid Advantage | Empire Medicaid Essent | $245 |
| Carelon Behavioral Health | Carelon Mvp & Emblem | $284 |
| United Healthcare Medicaid | UHC Essential Plan Medicaid | $304 |
| Blue Cross - FL | Blue Shield Of Ne New York HMO | $821 |
| Blue Shield - NY Highmark Northeastern | Blue Shield Of Ne New York Hm | $821 |
| Blue Cross - IL | Blue Shield Of Ne New York HMO | $821 |
| Blue Cross - Ia (Wellmark) | Blue Shield Of Ne New York HMO | $821 |
| Blue Cross - Ar | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - Az | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - Ak (Premera) | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - Al | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Shield - CA | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - Ri | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Shield - Pa (Highmark) | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - Pa (Capital) | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - Wa (Premera) | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - Va (Carefirst) | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - Vt | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - Ut (Regence) | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - TX | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - Tn | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - Mt | Blue Shield Of Ne New York PPO | $1,027 |
Inpatient
$225cash price (self-pay)
$225list price
$54.95–$385range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Commonwealth Care Alliance | Pb Xr 100% Default | $225 |
| Union Health Service | Pb Xr 100% Default | $225 |
| Everence | Pb Xr 100% Default | $225 |
| Harvard Pilgrim Healthcare | Pb Xr 100% Default | $225 |
| The Health Plan | Pb Xr 100% Default | $225 |
| Molina Medicare Advantage | Pb Xr 100% Default | $225 |
| Rx Allwin | Pb Xr 100% Default | $225 |
| Pace Of Southwest Michigan | Pb Xr 100% Default | $225 |
| Dentaquest | Pb Xr 100% Default | $225 |
| Health Choices | Pb Xr 100% Default | $225 |
| Security Health Medicaid | Pb Xr 100% Default | $225 |
| Amerihealth Caritas Medicaid | Pb Xr 100% Default | $225 |
| Healthcomp | Pb Xr 100% Default | $225 |
| Care Wisconsin Medicaid | Pb Xr 100% Default | $225 |
| Homestead Health Plans Woods Center | Pb Xr 100% Default | $225 |
| Ghc Scw Wi Badgercare | Pb Xr 100% Default | $225 |
| Dean Wi Badgercare | Pb Xr 100% Default | $225 |
| Jefferson Health Plan Commercial | Pb Xr 100% Default | $225 |
| Upper Peninsula Health Plan (Uphp) Medicaid | Pb Xr 100% Default | $225 |
| Humana Medicaid | Pb Xr 100% Default | $225 |
| Franklin Co Sheriff Dept | Pb Xr 100% Default | $225 |
| Cigna Medicaid Advantage | Pb Xr 100% Default | $225 |
| Pokagon Band Of Potawatom | Pb Xr 100% Default | $225 |
| Midwest- Operating Engineers | Pb Xr 100% Default | $225 |
| Wellcare Medicaid | Pb Xr 100% Default | $225 |
| Independent Living Center Of The Hudson Valley | Pb Xr 100% Default | $225 |
| Idaho Womens Health Check | Pb Xr 100% Default | $225 |
| Independent Health | Pb Xr 100% Default | $225 |
| Healthspan | Pb Xr 100% Default | $225 |
| Health New England | Pb Xr 100% Default | $225 |
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