CT abdomen and pelvis with contrast at Upper Valley Medical Center. CPT 74177.
What Upper Valley Medical Center publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$3,941cash price (self-pay)
$3,941list price
$342–$1,056range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medicare Hmo | Aetna Medicare | $342 |
| Medicare Hmo | Humana Medicare | $349 |
| Medicare Hmo | Communicare Advantage I-Snp | $352 |
| Medicare Hmo | Buckeye Medicare Advantage | $359 |
| Medicare Hmo | Devoted Health Plans | $362 |
| Uhc | United Healthcare | $436 |
| Uhc | United Healthcare All Savers | $436 |
| Uhc | United Healthcare Choice Plus | $436 |
| Uhc | United Healthcare Golden Rule | $436 |
| Uhc | United Healthcare Ppo | $436 |
| Uhc | United Healthcare River Valley | $436 |
| Uhc | United Healthcare Surest | $436 |
| Uhc | United Medical Resources | $436 |
| Anthem | Anthem Marketplace-Exchange Plans | $493 |
| Contracted Commercial | Caresource Marketplace | $513 |
| Anthem | Anthem Blue Connection High Performance Network | $792 |
| Medical Mutual | Medical Mutual Of Ohio | $987 |
| Anthem | Anthem Bcbs | $1,056 |
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