CT abdomen and pelvis with contrast at Alice Hyde Medical Center. CPT 74177.
What Alice Hyde Medical Center publishes for this service, straight from its standard-charges file, last updated April 28, 2026.
Outpatient / ER
$107cash price (self-pay)
$107list price
$55.42–$5,194range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| United Healthcare | Managed Medicaid/Essential Plans | $57.05 |
| MVP | Essential Plans | $69.28 |
| MVP | Managed Medicaid | $69.28 |
| Fidelis Care | Health Benefit Exchange Products | $89.65 |
| United Healthcare Empire Plan | Commercial PPO for NY State Employees | $94.56 |
| MVP | Individual Group Commercial | $121 |
| Capital District Physicians' Health Plan | Essential Plans | $124 |
| Capital District Physicians' Health Plan | Managed Medicaid | $124 |
| Excellus BlueCross BlueShield | Managed Medicaid/Essential Plans | $127 |
| Fidelis Care | Child Health Plus | $138 |
| Fidelis Care | Managed Medicaid | $144 |
| Fidelis Care | Essential Plans | $166 |
| MVP | Small/Large Group Commercial | $198 |
| Excellus BlueCross BlueShield | Commercial | $639 |
| Humana Military | TRICARE | $878 |
| Martins Point | TRICARE Prime/Department of Defense | $884 |
| Aetna | Medicare Advantage | $884 |
| Capital District Physicians' Health Plan | Medicare Advantage | $884 |
| MVP | Medicare Advantage | $884 |
| United Healthcare | Medicare Advantage | $884 |
| Veterans Affairs Community Care Network | Veterans Administration | $884 |
| ChoiceCare | Medicare Advantage | $886 |
| Excellus BlueCross BlueShield | Medicare Advantage | $887 |
| Fidelis Care | Medicare Advantage | $891 |
| St. Regis | HMO | $941 |
| ChoiceCare | Commercial | $2,020 |
| MagnaCare | Commercial | $2,152 |
| Aetna | Commercial | $2,331 |
| Highmark BlueShield | IND/FEP/PPO/HMO | $2,415 |
| Capital District Physicians' Health Plan | Commercial | $2,543 |
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