CT abdomen and pelvis with contrast at Health Alliance Mary Avenue Hospital. CPT 74177.
What Health Alliance Mary Avenue Hospital publishes for this service, straight from its standard-charges file, last updated June 24, 2026.
Outpatient / ER
$2,713cash price (self-pay)
$2,713list price
$303–$2,713range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna Medicare | Aetna Medicare | $433 |
| Beacon Medicare | Beacon Medicare | $433 |
| Blue Cross Medicare | Blue Cross Medicare | $433 |
| Cdphp Medicare | Cdphp Medicare | $433 |
| Hamaspik (Mcr) | Hamaspik (Mcr) | $433 |
| Medicare Managed 100% Hahv | Medicare Managed 100 Hahv | $433 |
| Mvp Gold (Mcr) | Mvp Gold (Mcr) | $433 |
| Todays Options Medicare | Todays Options Medicare | $433 |
| Medicare | Medicare | $435 |
| Emblem Ghi/Hip Medicare | Emblem Ghi/Hip Medicare | $442 |
| Affinity By Molina Mcr | Affinity By Molina Mcr | $455 |
| Todays Options | Todays Options | $477 |
| Beacon Exchange | Beacon Exchange | $520 |
| Beacon Commercial | Beacon Commercial | $563 |
| UHC Commercial | UHC Commercial | $611 |
| UHC Empire | UHC Empire | $611 |
| UHC Exchange | UHC Exchange | $611 |
| VALUE OPTIONS (Non-HMO) | VALUE OPTIONS (Non-HMO) | $650 |
| Aetna Hp Network | Aetna Hp Network | $679 |
| Mvp HMO/PPO | Mvp HMO/PPO | $1,114 |
| Blue Cross Connection/Exchange | Blue Cross Connection/Exchange | $1,321 |
| Blue Cross Access | Blue Cross Access | $1,407 |
| Blue Cross Small Group | Blue Cross Small Group | $1,584 |
| Emblem Ghi/Hip PPO/Cbp | Emblem Ghi/Hip PPO/Cbp | $1,682 |
| Blue Cross Commercial/Healthy NY | Blue Cross Commercial/Healthy NY | $1,761 |
| Aetna | Aetna | $1,763 |
| Mvp Exchange | Mvp Exchange | $1,763 |
| Emblem Select Care (Exchange) | Emblem Select Care (Exchange) | $1,845 |
| Cdphp | Cdphp | $1,899 |
| First Health | First Health | $1,899 |
Inpatient
$2,713cash price (self-pay)
$2,713list price
$1,899–$2,713range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Magnacare Standard | Magnacare Standard | $1,899 |
| Multiplan | Multiplan | $2,225 |
| Blue Shield - Health Now | Blue Shield - Health Now | $2,577 |
| Medigap | Medigap | $2,713 |
| NON CONTRACTED (100% POC) | NON CONTRACTED (100 PerCent POC) | $2,713 |
Billed more than this?
Scan my billSnap a photo of your bill. We compare every line with these prices and coding rules, free.