CT abdomen and pelvis with contrast at Saint Michael's Medical Center. CPT 74177.
What Saint Michael's Medical Center publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$404cash price (self-pay)
$5,307list price
$324–$4,246range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Tricare | Tricare | $324 |
| UHC - Adhoc | UHC - Adhoc All Payer | $368 |
| UHC - Adhoc | UHC - Adhoc Oxford | $368 |
| Aetna | Aetna Medicare | $405 |
| Amerihealth | Amerihealth HMO Medicare | $405 |
| Horizon | Horizon Medicare | $405 |
| Horizon | Horizon NJ Health Duals (FIDESNP) | $405 |
| Humana | HUMANA MILITARY TRICARE | $405 |
| New Jersey Out of State | New Jersey Out of State | $405 |
| Traditional Medicare | Traditional Medicare | $405 |
| UHC | UHC Medicare (02-01-2023 to 12-31-2026) | $405 |
| Wellpoint Amerigroup | Wellpoint Amerigroup Medicare | $405 |
| Wellcare | Wellcare Medicare | $417 |
| Clover Health | Clover Medicare | $421 |
| Curana | Curana | $425 |
| Amerihealth | AmeriHealth HMO | $511 |
| Wellcare | Wellcare Insurance Exchange | $546 |
| UHC | UHC All Payer Commercial (02-01-2023 to 12-31-2026) | $552 |
| UHC | UHC Oxford Commercial (02-01-2023 to 12-31-2026) | $552 |
| Employer Direct Healthcare | Employer Direct Healthcare | $566 |
| Naphcare | Naphcare Medicare | $627 |
| Cigna | Cigna Commercial | $647 |
| Fairprice Healthcare Holdings - Fphh | Fairprice Healthcare Holdings - | $647 |
| Coventry | Coventry Auto | $809 |
| Coventry | Coventry Workers comp | $809 |
| Horizon | Horizon BCBS Of NJ HMO POS | $828 |
| Horizon | Horizon BCBS Of NJ Indemnity | $828 |
| Horizon | Horizon BCBS Of NJ PPO | $828 |
| Aetna | Aetna Commercial | $858 |
| Aetna | Aetna Medical Rental Network | $858 |
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