CT abdomen and pelvis with contrast at Providence Holy Family Hospital. CPT 74177.
What Providence Holy Family Hospital publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$955cash price (self-pay)
$4,274list price
$389–$1,440range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kaiser | Medicare Managed Care Plan | $389 |
| Blue Cross | Premera Medicare Managed Care Plan | $404 |
| Unitedhealthcare | Medicare Managed Care Plan | $416 |
| Blue Shield | Asuris Medicare Managed Care Plan | $420 |
| Amerigroup | Medicare Managed Care Plan | $428 |
| Community Health Plan | Cascade Care Exchange | $622 |
| Blue Cross | Premera - Lifewise Health Plan Of Washington Affordable C | $700 |
| Coordinated Care | Ambetter Exchange | $719 |
| Unitedhealthcare | Aco Tiered Other Commercial Plan | $726 |
| Blue Cross | Premera Heritage Exchange | $853 |
| Providence Health Plan | Signature/Choice/Extend Ppo Networks Other Co | $1,021 |
| Blue Cross | Premera All Commercial Plans | $1,092 |
| Kaiser | All Commercial Plans | $1,197 |
| Aetna | All Commercial Plans | $1,229 |
| Cigna | All Commercial Plans | $1,317 |
| Unitedhealthcare | Navigate Exchange | $1,383 |
| Unitedhealthcare | All Commercial Plans | $1,425 |
| Blue Shield | Asuris All Commercial Plans | $1,440 |
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