CT abdomen and pelvis with contrast at Gifford Medical Center. CPT 74177.
What Gifford Medical Center publishes for this service, straight from its standard-charges file, last updated February 12, 2026.
Outpatient / ER
$132cash price (self-pay)
$263list price
$81.74–$3,701range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Cross Blue Shield of New Hampshire | Qualified Health Plan | $116 |
| Blue Cross Blue Shield of Vermont | Medicare Advantage | $118 |
| Martins Point Health Care | Commercial | $118 |
| MVP Health Care of NY | Medicare Advantage | $118 |
| United Healthcare | Medicare Advantage | $118 |
| United Healthcare | VA CCN | $118 |
| Blue Cross Blue Shield of New Hampshire | SHOP On Exchange | $158 |
| Blue Cross Blue Shield of Vermont | Vermont Health Plan | $209 |
| Cigna | Commercial | $210 |
| Blue Cross Blue Shield of Vermont | Managed Care | $213 |
| Blue Cross Blue Shield of Vermont | Commercial | $224 |
| MVP Health Care of NY | Commercial | $224 |
| Multiplan | Commercial | $245 |
| Aetna of VT | Commercial | $250 |
| United Healthcare | Commercial | $250 |
| Blue Cross Blue Shield of New Hampshire | Commercial | $981 |
| Blue Cross Blue Shield of New Hampshire | SHOP Off Exchange | $981 |
| Harvard Pilgrim Health Care | HMO | $1,664 |
| Harvard Pilgrim Health Care | PPO | $1,664 |
Inpatient
$132cash price (self-pay)
$2,080list price
$195–$3,701range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Cross Blue Shield of New Hampshire | Commercial | $1,539 |
| Blue Cross Blue Shield of New Hampshire | SHOP Off Exchange | $1,539 |
| Blue Cross Blue Shield of Vermont | Vermont Health Plan | $1,664 |
| Cigna | Commercial | $1,664 |
| Harvard Pilgrim Health Care | HMO | $1,664 |
| Harvard Pilgrim Health Care | PPO | $1,664 |
| Blue Cross Blue Shield of Vermont | Managed Care | $1,747 |
| Blue Cross Blue Shield of Vermont | Commercial | $1,768 |
| MVP Health Care of NY | Commercial | $1,768 |
| Multiplan | Commercial | $1,934 |
| Aetna of VT | Commercial | $1,976 |
| United Healthcare | Commercial | $1,976 |
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