CT abdomen and pelvis with contrast at HSS West Side Outpatient Center. CPT 74177.
What HSS West Side Outpatient Center 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 | Medicaid Managed Care | $91.25 |
| Metro Plus | Essential Plans 3,4 | $91.25 |
| Emblem | Medicare Managed Care | $93.18 |
| Metro Plus | Essential Plans 1,2 | $95.05 |
| Blue Cross Blue Shield NY [1022] | BCBS NY Exchange [102200] | $109 |
| Emblem | City of NY Plans | $123 |
| Emblem | Commercial | $123 |
| NYSHIP | Commercial | $139 |
| UHC | Commercial | $144 |
| CIGNA | Commercial | $191 |
| Aetna | Commercial | $220 |
| Horizon | Commercial | $225 |
| Fidelis Essential [1323] | Fidelis Essential [132300] | $245 |
| Blue Cross Blue Shield NY [1022] | BCBS Individual Network [102218] | $294 |
| United Healthcare [1107] | United Healthcare Compass [110707] | $651 |
| Cigna [1035] | Cigna Great West [103506] | $771 |
| Qualcare [1101] | Qualcare [110100] | $771 |
| Wellfleet [1361] | Wellfleet - Cigna [136100] | $771 |
| Cigna [1035] | Cigna EPO [103502] | $771 |
| Nalc [1090] | Nalc [109000] | $771 |
| Cigna [1035] | Cigna PPO [103504] | $771 |
| Cigna [1035] | Cigna HMO [103503] | $771 |
| Oxford [1096] | Oxford [109600] | $823 |
| Oxford [1096] | Oxford HMO [109605] | $823 |
| Oxford [1096] | Oxford Liberty [109604] | $823 |
| Cigna [1035] | Cigna International [103507] | $857 |
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