CT abdomen and pelvis with contrast at Ascension Via Christi Hospital Manhattan. CPT 74177.
What Ascension Via Christi Hospital Manhattan publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$206cash price (self-pay)
$5,640list price
$71.10–$925range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kancare UHC | 859_medicaid Advantage Kancare United Health Care 202507 | $116 |
| Kancare Amerigroup | 857_medicaid Advantage Kancare Amerigroup 2025070 | $117 |
| Kancare Aetna | 856_medicaid Advantage Kancare Aetna 20250701 | $120 |
| Kancare Healthy Blue | 861_medicaid Advantage Kancare Healthy Blue 202 | $120 |
| Kancare Sunflower | 858_medicaid Advantage Kancare Sunflower 20250701 | $120 |
| Providrs Care | 867_mhks Providrs Care 20250701 | $305 |
| Default - 100 Percent Of Medicare | 622_default - 100 Percent Of Medic | $330 |
| Medicare Advantage Coventry | 816_mhks Medicare Advantage Coventry Out | $330 |
| Medicare Advantage Humana | 814_medicare Advantage Humana Outpatient 2 | $330 |
| Medicare Advantage Other | 817_mhks Medicare Advantage Other Outpatien | $330 |
| Va | 624_veterans Affairs Outpatient 20230101 | $330 |
| Aarp Medicare Replacement | 813_medicare Advantage Aarp Outpatient 202 | $334 |
| Humana | 872_humana 20251001 | $334 |
| Medicare Advantage Allwell | 815_mhks Medicare Advantage Allwell Outpa | $337 |
| Medicare Advantage United Health Care | 818_mhks Medicare Advantage Un | $337 |
| Smarthealth | 655_mhks Smarthealth Outpatient 20230101 | $462 |
| Tricare | 623_tricare Outpatient 20230101 | $483 |
| BCBS Choice | 843_blue Cross Blue Shield Choice Mhks 20250101 | $520 |
| BCBS Cap | 842_blue Cross Blue Shield Cap Mhks 20250101 | $548 |
| Ambetter | 701_ambetter Sunflower Outpatient Mhks 20230101 | $561 |
| United Healthcare Exchange | 865_mhks United Healthcare Exchange Outpa | $925 |
Inpatient
$206cash price (self-pay)
$515list price
$71.10–$925range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Providrs Care | 867_mhks Providrs Care 20250701 | $305 |
| Default - 100 Percent Of Medicare | 874_default - 100 Percent Of Medic | $330 |
| Medicare Advantage Coventry | 879_mhks Medicare Advantage Coventry Inp | $330 |
| Medicare Advantage Humana | 878_medicare Advantage Humana Inpatient 20 | $330 |
| Medicare Advantage Other | 881_mhks Medicare Advantage Other Inpatient | $330 |
| Va | 873_veterans Affairs Inpatient 20251001 | $330 |
| Aarp Medicare Replacement | 877_medicare Advantage Aarp Inpatient 2025 | $334 |
| Medicare Advantage Allwell | 885_mhks Medicare Advantage Allwell Inpat | $337 |
| Medicare Advantage United Health Care | 887_mhks Medicare Advantage Un | $337 |
| Smarthealth | 883_mhks Smarthealth Inpatient 20251001 | $462 |
| Ambetter | 886_ambetter Sunflower Inpatient Mhks 20251001 | $561 |
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All common services at Ascension Via Christi Hospital Manhattan