CT abdomen and pelvis with contrast at Plaistow Emergency Room. CPT 74177.
What Plaistow Emergency Room publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$7,011cash price (self-pay)
$7,011list price
$217–$6,660range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| AmeriHealth Caritas | MCD | $217 |
| Well Sense Health Plan | MCD | $525 |
| Anthem | BlueChoice | $1,183 |
| Harvard Pilgrim | INDIVIDUAL | $1,239 |
| Anthem | FEP | $1,360 |
| Anthem | PPO | $1,360 |
| Harvard Pilgrim | ELEVATE | $1,363 |
| Anthem | HMO | $1,370 |
| Anthem | POS | $1,370 |
| United | FreedomBenefitPlans | $1,472 |
| Harvard Pilgrim | HMO | $1,549 |
| Harvard Pilgrim | POS | $1,549 |
| Maine Community Health | Individual | $2,192 |
| Maine Community Health | SmallGroup | $2,192 |
| United | AllPayerAppendix | $2,945 |
| Harvard Pilgrim | PPO | $3,156 |
| Maine Community Health | LargeGroup | $3,715 |
| Tufts Health Plan | POS | $4,010 |
| Tufts Health Plan | HMO | $4,131 |
| Tufts Health Plan | PPO | $4,131 |
| Aetna | HMO | $4,172 |
| United | OptionsPPO | $4,256 |
| Aetna | EPO | $4,683 |
| Aetna | POS | $4,683 |
| Aetna | PPO | $4,683 |
| CorVel | WorkersComp | $5,048 |
| EverNorth | COMM | $5,609 |
| Healthcare Value Mgmt | COMM | $5,889 |
| First Health | PPO | $5,959 |
| Oxford Health Plans | COMM | $6,660 |
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