CT abdomen and pelvis with contrast at Saint Clares Behavioral Health – Boonton. CPT 74177.
What Saint Clares Behavioral Health – Boonton publishes for this service, straight from its standard-charges file, last updated September 10, 2026.
Outpatient / ER
$404cash price (self-pay)
$1,929list price
$324–$1,640range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Humana | HUMANA MILITARY TRICARE | $324 |
| UHC - Adhoc | UHC - Adhoc All Payer | $368 |
| UHC - Adhoc | UHC - Adhoc Oxford | $368 |
| Aetna | Aetna Medicare | $405 |
| Amerihealth | Amerihealth HMO Medicare | $405 |
| Clover Health | Clover Medicare | $405 |
| Horizon | Horizon Medicare | $405 |
| Traditional Medicare | Traditional Medicare | $405 |
| Tricare | Tricare | $405 |
| UHC | UHC Medicare | $405 |
| Wellcare | Wellcare Medicare | $405 |
| Wellpoint Amerigroup | Wellpoint Amerigroup Medicare | $405 |
| ALLY-ALIGN (fka Spartan Health Plan) | ALLY-ALIGN (fka Spartan Health | $425 |
| Amerihealth | Amerihealth HMO | $511 |
| Wellcare | Wellcare Insurance Exchange (01-01-2022 to 12-31-2026) | $546 |
| UHC | UHC Commercial All Payers | $552 |
| UHC | UHC Commercial Oxford | $552 |
| Employer Direct Healthcare | Employer Direct Healthcare | $566 |
| BRIGHTON HEALTH PLAN SOLUTIONS (FKA MagnaCare) | BRIGHTON HEALTH PLAN | $597 |
| Cigna | Cigna Commercial | $625 |
| Fairprice Healthcare Holdings - Fphh | Fairprice Healthcare Holdings - | $647 |
| Coventry | Coventry Auto | $809 |
| Coventry | Coventry workers comp | $809 |
| Horizon | Horizon BCBS of NJ HMO POS | $841 |
| Horizon | Horizon BCBS of NJ Indemnity | $841 |
| Horizon | Horizon BCBS of NJ PPO | $841 |
| Aetna | Aetna Commercial | $858 |
| Aetna | Aetna Medical Rental Network | $858 |
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All common services at Saint Clares Behavioral Health – Boonton