CT abdomen and pelvis with contrast at Portsmouth Amublance. CPT 74177.
What Portsmouth Amublance publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$13,697cash price (self-pay)
$13,697list price
$364–$13,012range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| AmeriHealth Caritas | MCD | $564 |
| Anthem | BlueChoice | $986 |
| Anthem Maine | BlueChoice | $986 |
| Anthem | FEP | $1,095 |
| Anthem | HMO | $1,095 |
| Anthem | POS | $1,095 |
| Anthem | PPO | $1,095 |
| Anthem Maine | FEP | $1,095 |
| Anthem Maine | HMO | $1,095 |
| Anthem Maine | POS | $1,095 |
| Anthem Maine | PPO | $1,095 |
| Well Sense Health Plan | MCD | $1,120 |
| Harvard Pilgrim | INDIVIDUAL | $1,328 |
| Harvard Pilgrim | ELEVATE | $1,461 |
| Harvard Pilgrim | PPO | $1,600 |
| Harvard Pilgrim | HMO | $1,660 |
| Harvard Pilgrim | POS | $1,660 |
| United | FreedomBenefitPlans | $3,520 |
| Maine Community Health | Individual | $4,283 |
| Maine Community Health | SmallGroup | $4,283 |
| Tufts Health Plan | HMO | $5,150 |
| Tufts Health Plan | PPO | $5,150 |
| United | AllPayerAppendix | $6,273 |
| Maine Community Health | LargeGroup | $7,258 |
| Tufts Health Plan | POS | $7,835 |
| Aetna | EPO | $8,670 |
| Aetna | HMO | $8,670 |
| Aetna | POS | $8,670 |
| Aetna | PPO | $8,670 |
| United | OptionsPPO | $9,040 |
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