CT abdomen and pelvis with contrast at Champlain Valley Physicians Hospital. CPT 74177.
What Champlain Valley Physicians Hospital publishes for this service, straight from its standard-charges file, last updated April 28, 2026.
Outpatient / ER
$244cash price (self-pay)
$244list price
$57.05–$5,332range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| United Healthcare | Managed Medicaid/Essential Plans | $57.05 |
| MVP | Essential Plans | $69.28 |
| MVP | Managed Medicaid | $69.28 |
| Empire BlueCross BlueShield | Essential Plans/Managed Medicaid | $73.35 |
| Empire BlueCross BlueShield | Managed Medicaid Aliessa | $73.35 |
| Fidelis Care | Managed Medicaid | $81.50 |
| Fidelis Care | Essential Plans | $85.58 |
| United Healthcare Empire Plan | Commercial PPO for NY State Employees | $94.96 |
| Excellus BlueCross BlueShield | Managed Medicaid/Essential Plans | $145 |
| Capital District Physicians' Health Plan | Essential Plans | $183 |
| Capital District Physicians' Health Plan | Managed Medicaid | $183 |
| MVP | Commercial | $198 |
| Excellus BlueCross BlueShield | Medicare Advantage | $247 |
| Humana Military | TRICARE | $248 |
| Aetna | Medicare Advantage | $259 |
| Capital District Physicians' Health Plan | Medicare Advantage | $259 |
| Empire BlueCross BlueShield | Medicare Advantage | $259 |
| Fidelis Care | Medicare Advantage | $259 |
| United Healthcare | Medicare Advantage | $259 |
| Veterans Affairs Community Care Network | Veterans Administration | $259 |
| MVP | Medicare Advantage | $260 |
| Martins Point | TRICARE Prime/Department of Defense | $274 |
| St. Regis | HMO | $316 |
| Wellpath | FCI Ray Brook | $384 |
| Empire BlueCross BlueShield | Individual Network | $414 |
| Excellus BlueCross BlueShield | Commercial | $1,097 |
| Empire BlueCross BlueShield | Blue Access | $1,751 |
| Empire BlueCross BlueShield | HMO | $1,837 |
| Empire BlueCross BlueShield | IND | $1,840 |
| Empire BlueCross BlueShield | PPO | $1,842 |
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