CT abdomen and pelvis with contrast at WTH Bolivar Hospital. CPT 74177.
What WTH Bolivar Hospital publishes for this service, straight from its standard-charges file, last updated June 2, 2026.
Outpatient / ER
$201cash price (self-pay)
$670list price
$161–$794range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Veterans Affairs | Community Care Network | $161 |
| Blue Cross Blue Shield of Tennessee | BlueCare | $166 |
| Blue Cross Blue Shield of Tennessee | BlueChoice HMO | $166 |
| Cigna-HealthSpring | Medicare Advantage | $167 |
| River Valley Plan | TennCare | $195 |
| United Healthcare | All Payer | $363 |
| Aetna | Commercial | $462 |
| Blue Cross Blue Shield of Tennessee | Network S/E | $476 |
| Blue Cross Blue Shield of Tennessee | Network P | $517 |
| Celtic Insurance Company | Commercial-Exchange | $552 |
| Oscar | HMO/Medicare Advantage/PPO/EPO/POS | $650 |
| Aetna | AWH/Vanderbilt Health Affiliated Network (VHAN)/VHAN - Employe | $794 |
Inpatient
$201cash price (self-pay)
$670list price
$462–$462range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna | Commercial | $462 |
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