CT abdomen and pelvis with contrast at Maimonides Medical Center. CPT 74177.
What Maimonides Medical Center publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$240cash price (self-pay)
$1,840list price
$18.90–$1,324range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem | Medicare Advantage PPO | $18.90 |
| United Community Plan | Medicaid HMO | $41.76 |
| United Healthcare | Essential Plan 3-4 | $41.76 |
| Anthem Health Plus | Essential Plan 1-2 | $51.98 |
| Anthem Health Plus | Child Health Plus | $51.98 |
| Anthem Health Plus | Medicaid HMO | $52.34 |
| Anthem Health Plus | Commercial PPO | $52.70 |
| Healthfirst | Medicare Advantage HMO | $73.71 |
| United Healthcare | Medicare Advantage HMO | $74.09 |
| Anthem Health Plus | Medicare Advantage HMO | $74.09 |
| Healthfirst | Essential Plan | $74.21 |
| Healthfirst | Medicaid HMO | $75.60 |
| Emblem Health - HIP | Essential Plan 1-2 | $76.04 |
| Fidelis | Medicaid HMO | $76.04 |
| Centers Plan for Healthy Living | Medicaid HMO | $76.04 |
| Emblem Health - HIP | Child Health Plus | $76.04 |
| Fidelis | Essential Plan 3-4 | $77.84 |
| Fidelis | Essential Plan 1-2 | $79.84 |
| Aetna | Medicare Advantage HMO | $92.61 |
| Aetna | Medicare Advantage PPO | $92.61 |
| Anthem Health Plus | Medicare Advantage PPO | $92.61 |
| Fidelis | Medicare Advantage HMO | $92.66 |
| Elderplan | Medicare Advantage HMO | $92.95 |
| Elderplan | Medicaid HMO | $94.32 |
| Centers Plan for Healthy Living | Medicare Advantage HMO | $94.50 |
| Emblem Health - HIP | Commercial HMO | $94.50 |
| Emblem Health - GHI | Commercial PPO | $95.81 |
| Cigna | Commercial PPO | $100 |
| Anthem | Exchange Plan Silver | $106 |
| Centivo | Commercial HMO | $129 |
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