CT abdomen and pelvis with contrast at Saint Alphonsus Medical Center Baker City. CPT 74177.
What Saint Alphonsus Medical Center Baker City publishes for this service, straight from its standard-charges file, last updated March 31, 2026.
Outpatient / ER
$2,813cash price (self-pay)
$4,328list price
$167–$4,241range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medicaid - Id | Medicaid | $202 |
| Pacificsource Health Plans | Pacificsource Smart Alliance | $636 |
| Moda Health | Moda Select | $678 |
| Blue Cross - Ri | Regence Bs | $975 |
| Blue Cross - Ok | Regence Bs | $975 |
| Blue Cross - Or (Regence) | Regence Bs | $975 |
| Blue Cross - Pa (Independence) | Regence Bs | $975 |
| Blue Cross - NY (Excellus) | Regence Bs | $975 |
| Blue Shield - NY Highmark Western | Regence Bs | $975 |
| Blue Shield - NY Highmark Northeastern | Regence Bs | $975 |
| Blue Cross - Nc | Regence Bs | $975 |
| Blue Cross - Wi (Anthem) | Regence Bs | $975 |
| Kaiser Domestic | Regence Bs | $975 |
| Blue Cross - Ks | Regence Bs | $975 |
| Blue Cross - Mo (Anthem) | Regence Bs | $975 |
| Blue Cross - Nd | Regence Bs | $975 |
| Blue Cross - Nm | Regence Bs | $975 |
| Blue Cross - Vt | Regence Bs | $975 |
| Blue Cross - Va (Anthem) | Regence Bs | $975 |
| Blue Cross - Mn | Regence Bs | $975 |
| Blue Cross - IL Alternate | Regence Bs | $975 |
| Blue Cross - Mi | Regence Bs | $975 |
| Blue Cross - Va (Carefirst) | Regence Bs | $975 |
| Blue Cross - Sc | Regence Bs | $975 |
| Blue Cross - Tn | Regence Bs | $975 |
| Blue Cross - TX | Regence Bs | $975 |
| Blue Cross - Ut (Regence) | Regence Bs | $975 |
| Blue Cross - Pa (Capital) | Regence Bs | $975 |
| Blue Cross - Nj (Horizon) | Regence Bs | $975 |
| Blue Cross - Nh (Anthem) | Regence Bs | $975 |
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All common services at Saint Alphonsus Medical Center Baker City