CT abdomen and pelvis with contrast at Santiam Memorial Hospital. CPT 74177.
What Santiam Memorial Hospital publishes for this service, straight from its standard-charges file, last updated August 6, 2026.
Outpatient / ER
$553cash price (self-pay)
$3,082list price
$51.00–$10,018range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Providence Pebb Profee Only | Providence Pebb Profee Only | $58.00 |
| Pacific Source Smrt Hlth Profee | Pacific Source Smrt Hlth Profee | $59.00 |
| Atrio Spcl Needs Mcr Adv Profee | Atrio Spcl Needs Mcr Adv Profee | $90.93 |
| Age Right Mcr Adv - All Plans | Age Right Mcr Adv - All Plans | $392 |
| Humana Mcr Adv - All Plans | Humana Mcr Adv - All Plans | $392 |
| Pacific Source Mcr Adv | Pacific Source Mcr Adv | $392 |
| Regence Mcr Adv - All Other Plans | Regence Mcr Adv - All Other Plans | $392 |
| Atrio Mcr Adv - All Plans | Atrio Mcr Adv - All Plans | $392 |
| Care Oregon Mcr Adv - All Plans | Care Oregon Mcr Adv - All Plans | $392 |
| Providence Mcare Adv | Providence Mcare Adv | $392 |
| UHC Mcr Adv | UHC Mcr Adv | $392 |
| Health Net Mcr Adv | Health Net Mcr Adv | $404 |
| Kaiser Mcr Adv | Kaiser Mcr Adv | $404 |
| Samaritan Mcr Adv - All Plans | Samaritan Mcr Adv - All Plans | $411 |
| Devoted Health Mcr Adv - All Plans | Devoted Health Mcr Adv - All Plan | $415 |
| Kaiser Mcaid | Kaiser Mcaid | $986 |
| Ihn Mcaid - All Plans | Ihn Mcaid - All Plans | $986 |
| Pacific Source Mcaid - All Other Plans | Pacific Source Mcaid - All Ot | $1,085 |
| Pacific Source Comm | Pacific Source Comm | $2,377 |
| Aetna - All Plans | Aetna - All Plans | $2,392 |
| Kaiser Comm - All Other Plans | Kaiser Comm - All Other Plans | $2,554 |
| UHC Comm - All Other Plans | UHC Comm - All Other Plans | $2,589 |
| Cigna - All Plans | Cigna - All Plans | $2,598 |
| Moda Comm - All Other Plans | Moda Comm - All Other Plans | $2,620 |
| Providence Comm - All Other Plans | Providence Comm - All Other Plans | $2,620 |
| First Choice - All Plans | First Choice - All Plans | $2,928 |
| Health Net Comm - All Other Plans | Health Net Comm - All Other Plans | $2,928 |
| Multiplan - All Other Plans | Multiplan - All Other Plans | $2,928 |
| Regence Comm | Regence Comm | $10,018 |
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