CT abdomen and pelvis with contrast at Montefiore Medical Center. CPT 74177.
What Montefiore Medical Center publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$1,504cash price (self-pay)
$2,300list price
$76.04–$34,201range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medicare | Part B - PA's & NP's | $80.33 |
| Wellcare | Medicaid - PAs & NPs | $80.33 |
| United | Empire Plan MD/Dos | $89.78 |
| BCBS | Medicare | $92.95 |
| Oscar | Medicare | $94.50 |
| Medicare | Part B | $94.50 |
| Fidelis | Medicaid and HARP | $94.50 |
| Wellcare | Medicaid Specialists | $94.50 |
| Humana | Medicare | $96.39 |
| 1199 | 1199 | $99.21 |
| Affinity | Medicaid - Specialists | $99.43 |
| HIP | Medicaid Essential Plan 1-4 | $100 |
| Wellcare | Medicare - PAs & NPs | $102 |
| HIP | Medicare | $106 |
| Wellcare | Medicaid - OB/GYN | $109 |
| Medicaid | Medicaid | $109 |
| Wellcare | Medicare-PCPs | $111 |
| Wellcare | Medicare Specialists | $111 |
| Fidelis | Medicare | $114 |
| New York Medicaid | Medicaid | $129 |
| BCBS | MHS Employees | $147 |
| Oscar | Commercial | $174 |
| Multiplan | Multiplan | $257 |
| UHC/Oxford | Commercial Midlevels | $350 |
| Aetna | Medicare | $352 |
| MetroPlus | Default Duals | $394 |
| MetroPlus | Medicaid Advantage Plus | $394 |
| MetroPlus | Medicare | $394 |
| Cigna | Cigna Paraprofessionals | $397 |
| Hip | HMO/POS | $415 |
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