CT abdomen and pelvis with contrast at Frisbie Memorial Hospital. CPT 74177.
What Frisbie Memorial Hospital publishes for this service, straight from its standard-charges file, last updated March 1, 2026.
Outpatient / ER
$8,348cash price (self-pay)
$8,348list price
$437–$6,678range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| AmeriHealth Caritas | MCD | $688 |
| Well Sense Health Plan | MCD | $1,019 |
| Anthem | BlueChoice | $1,183 |
| Anthem | HPN | $1,241 |
| Anthem | FEP | $1,369 |
| Anthem | PPO | $1,369 |
| Anthem | HMO | $1,379 |
| Anthem | IndividualOffExhange | $1,379 |
| Anthem | POS | $1,379 |
| Harvard Pilgrim | INDIVIDUAL | $2,216 |
| Maine Community Health | Individual | $2,382 |
| Maine Community Health | SmallGroup | $2,382 |
| Harvard Pilgrim | ELEVATE | $2,683 |
| Tufts Health Plan | HMO | $2,863 |
| Tufts Health Plan | PPO | $2,863 |
| United | FreedomBenefitPlans | $2,863 |
| Harvard Pilgrim | HMO | $3,382 |
| Harvard Pilgrim | POS | $3,382 |
| Harvard Pilgrim | PPO | $3,382 |
| United | AllPayerAppendix | $3,498 |
| Maine Community Health | LargeGroup | $4,035 |
| Tufts Health Plan | POS | $4,775 |
| Aetna | EPO | $4,825 |
| Aetna | HMO | $4,825 |
| Aetna | POS | $4,825 |
| Aetna | PPO | $4,825 |
| United | OptionsPPO | $5,034 |
| EverNorth | COMM | $6,678 |
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