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CT scan of abdomen and pelvis with contrast

2020 CPT/HCPCS 74177
Negotiated Private Fee $500.00
Prossam $450.00
Champva $341.28
First Medical $275.00
First Medical Vital $168.57
Plan de Salud Menonita $382.50
Menonita Vital $255.37
Humana Gold plus/ Gold choice Ambulatory Payment classification (APC)
Humana $427.50
Mapfre $400.00
Mcs Classicare $336.00
MCS Life $381.00
Medicare Ambulatory Payment classification (APC)
MMM $301.00
MMM Vital $234.11
Panamerican Life Not covered
PMC $183.82
Tricare $335.34
Triple S Salud $450.00
Triple S Vital $217.54
Triple S Advantage Ambulatory Payment classification (APC)
Negotiated Minimum Charge $217.54
Negotiated Maximus Charge $450.00
Discounted Cash Price $400.00

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