CT abdomen and pelvis with contrast at St. Mary's General Hospital. CPT 74177.
What St. Mary's General Hospital publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$412cash price (self-pay)
$5,307list price
$330–$4,511range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Humana | Humana Military Tricare | $330 |
| UHC - Adhoc | UHC - Adhoc All Payer | $368 |
| UHC - Adhoc | UHC - Adhoc Oxford | $368 |
| Aetna | Aetna Medicare | $412 |
| Americhoice (UHC) | UHC Medicare | $412 |
| Amerihealth | Amerihealth Medicare | $412 |
| Clover Health | Clover Medicare | $412 |
| Horizon | Horizon Medicare | $412 |
| Traditional Medicare | Traditional Medicare | $412 |
| Tricare | Tricare | $412 |
| Wellcare | Wellcare Medicare | $412 |
| Wellpoint Amerigroup | Wellpoint Amerigroup Medicare | $412 |
| Ally-Align (Fka Spartan Plan Nj, Inc.) | Ally-Align (Fka Spartan Plan | $433 |
| Amerihealth | Amerihealth HMO | $511 |
| UHC | UHC All Payer (02-01-2023 to 12-31-2026) | $552 |
| UHC | UHC Oxford (02-01-2023 to 12-31-2026) | $552 |
| Wellcare | Wellcare Insurance Exchange | $557 |
| Employer Direct Healthcare | Employer Direct Healthcare | $577 |
| Cigna | Cigna Commercial | $606 |
| Fairprice Healthcare Holdings | Fairprice Healthcare Holdings | $660 |
| Horizon | Horizon BCBS Of NJ HMO POS | $731 |
| Horizon | Horizon BCBS Of NJ Indemnity | $731 |
| Horizon | Horizon BCBS Of NJ PPO | $731 |
| Coventry | Coventry Auto | $825 |
| Coventry | Coventry Workers Compensation | $825 |
| Aetna | Aetna Commercial | $874 |
| Aetna | Aetna Medical Rental Network | $874 |
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