CT abdomen and pelvis with contrast at Southwestern Vermont Medical Center. CPT 74177.
What Southwestern Vermont Medical Center publishes for this service, straight from its standard-charges file, last updated January 1, 2025.
Outpatient / ER
$3,387cash price (self-pay)
$4,839list price
$64.76–$4,694range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| MVP | Medicaid | $64.76 |
| MVP | Essential plan 1,2,5,6 | $77.71 |
| UHC | Medicaid | $77.71 |
| CDPHP | Essential Plan 3 & 4 | $146 |
| CDPHP | Essential Plan 1 & 2 | $146 |
| CIGNA | Medicare Advantage | $365 |
| CDPHP | Medicare | $365 |
| Blue Cross | Medicare | $365 |
| Fidelis | Medicare | $365 |
| HNE | Medicare | $365 |
| Humana | Medicare | $365 |
| MVP | Medicare | $365 |
| UHC | Medicare | $365 |
| Wellcare | Medicare | $365 |
| Fidelis | Medicaid | $365 |
| Fidelis | CHP | $365 |
| Fidelis | Essential (Aliessa) | $365 |
| Aetna | Medicare | $365 |
| Fidelis | Exchange (QHP) | $383 |
| Fidelis | Essential | $383 |
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