CT abdomen and pelvis with contrast at Northern Maine Medical Center. CPT 74177.
What Northern Maine Medical Center publishes for this service, straight from its standard-charges file, last updated March 25, 2026.
Outpatient / ER
$30.00cash price (self-pay)
$1,025list price
$78.65–$1,906range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Tricare | Tricare | $243 |
| Martins_point | Martins Point Health Care | $244 |
| Aetna_mcradv | Aetna Medicare Advantage | $563 |
| Generations_mcradv | Generations Medicare Advantage | $563 |
| Humana_mcradv | Humana Medicare Adavantage | $563 |
| Micmac Health | Micmac Health | $563 |
| Uhc_mcradv | United Healthcare Medicare Advantage | $563 |
| Vaccn | Veterans Community Care Network | $563 |
| Wellcare | Wellcare | $563 |
| Anthem_mcradv | Anthem Medicare Advantage | $575 |
| Twin_rivers | Twin Rivers | $871 |
| Harvard_pilgrim | Harvard Pilgrim Health Care | $909 |
| Anthem | Anthem Blue Cross Blue Shield | $923 |
| Maine_comm_health | Maine Community Health Options | $943 |
| Aetna | Aetna | $953 |
| Choicecare | Choicecare-Humana | $973 |
| Multiplan | Multiplan | $973 |
| UHC | UHC | $973 |
| Cigna_ppo | Cigna PPO | $994 |
| Mainecare | Mainecare | $1,025 |
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