CT abdomen and pelvis with contrast at Hospital for Special Surgery Main Hospital. CPT 74177.

What Hospital for Special Surgery Main Hospital publishes for this service, straight from its standard-charges file, last updated April 1, 2026.

Outpatient / ER

$615cash price (self-pay)

$615list price

$65.23–$2,289range insurers pay

Insurance plan	Negotiated rate
UHC \| Medicare Managed Care	$65.23
Fidelis \| Medicaid Managed Care	$68.44
Fidelis \| Essential Plans 1,2	$72.24
Fidelis \| Essential Plans 3,4	$72.24
Metro Plus \| Essential Plans 3,4	$91.25
Metro Plus \| Medicaid Managed Care	$91.25
Emblem \| Medicare Managed Care	$93.18
Metro Plus \| Essential Plans 1,2	$95.05
Emblem \| Commercial	$123
Emblem \| City of NY Plans	$123
NYSHIP \| Commercial	$139
UHC \| Commercial	$144
United Healthcare [1107] \| Unitedhealthcare Essential 3 And 4 [110714]	$147
United Healthcare [1107] \| Unitedhealthcare Essential Group 1 [110713]	$147
CIGNA \| Commercial	$191
Aetna \| Commercial	$220
Horizon \| Commercial	$225
United Healthcare [1107] \| United Healthcare Compass [110707]	$651
United Healthcare [1107] \| United Healthcare Exchange [110711]	$651
Oxford [1096] \| Oxford Freedom Plan Select [109602]	$823
Oxford [1096] \| Oxford Freedom [109601]	$823
Oxford [1096] \| Oxford Healthy Start [109603]	$823
Daniel H Cook - Cigna [1339] \| Daniel H Cook - Cigna [133900]	$857
Luminare - Cigna [1362] \| Luminare - Cigna [136200]	$857
Nalc [1090] \| Nalc [109000]	$857
Allied Benefit System - Cigna Network [1337] \| Allied Benefit System -	$857
Apwu [1016] \| Apwu [101600]	$857
Geha [1053] \| Geha - Unitedhealthcare [105301]	$1,030
United Healthcare [1107] \| United Healthcare EPO [110704]	$1,030
United Healthcare [1107] \| United Healthcare HMO [110701]	$1,030

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