CT abdomen and pelvis with contrast at St. Charles Prineville. CPT 74177.

What St. Charles Prineville publishes for this service, straight from its standard-charges file, last updated April 1, 2026.

Outpatient / ER

$3,895cash price (self-pay)

$4,869list price

$246–$4,772range insurers pay

Insurance plan	Negotiated rate
MODA MEDICAID [528] \| Eastern Oregon CCO	$246
AUTO ALLSTATE INSURANCE [602] \| Auto Insurance	$506
AUTO STATE FARM CLAIMS [609] \| Auto Insurance	$506
OTJ TRISTAR [673] \| Oregon Workers Compensation	$506
AUTO COUNTRY INSURANCE CLAIMS [604] \| Auto Insurance	$506
GENERIC AUTO [649] \| Auto Insurance	$506
AUTO AMERICAN FAMILY INSURANCE [603] \| Auto Insurance	$506
AUTO SAFECO CONCENTRA [600] \| Auto Insurance	$506
AUTO DAIRYLAND INSURANCE [617] \| Auto Insurance	$506
AUTO GEICO CLAIMS OREGON [606] \| Auto Insurance	$506
AUTO LIBERTY MUTUAL AUTO INS [613] \| Auto Insurance	$506
AUTO TRAVELERS INSURANCE [615] \| Auto Insurance	$506
OTJ ESIS WEST WC CLAIMS [653] \| Oregon Workers Compensation	$506
OTJ CCMSI [618] \| Oregon Workers Compensation	$506
OTJ CHARTIS CLAIMS [650] \| Oregon Workers Compensation	$506
OTJ DEPT OF LABOR FEDERAL EMP [652] \| US Dept of Labor	$519
KAISER PERMANENTE [334] \| OEBB PEBB Non-Contracted	$768
BLUE CROSS [200] \| Blue Cross Individual	$1,121
BRIDGESPAN [342] \| Blue Cross Individual	$1,121
HEALTHCARE MANAGEMENT ADMIN [201] \| Blue Cross PPO	$1,319
CHAMP VA [700] \| Veteran Affairs	$1,363
CIGNA MEDICARE [143] \| Medicare	$1,363
ATRIO HEALTH MEDICARE [138] \| Medicare	$1,363
INDIAN HEALTH [704] \| Medicare	$1,363
Law Enforcement [701] \| Schs Sph Hb Law Enforcement	$1,363
HUMANA MEDICARE [130] \| Medicare	$1,363
UNICARE [133] \| Medicare	$1,363
SAMARITAN HEALTH PLAN MED ADV [141] \| Medicare	$1,363
BLUE CROSS MED ADV [125] \| Blue Cross Medicare	$1,500
UMPQUA HEALTH [533] \| Oregon Medicaid CCO	$1,704

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