CT abdomen and pelvis with contrast at Montefiore Mount Vernon Hospital. CPT 74177.
What Montefiore Mount Vernon Hospital publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$3,465cash price (self-pay)
$5,331list price
$109–$4,691range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Emblem | Essential Plan 3 & 4 | $109 |
| Emblem | Medicaid FHP CHP | $109 |
| Medicaid | Medicaid | $109 |
| VNSNY Choice | Medicaid | $125 |
| VNSNY Select Health | VNSNY Select Health | $125 |
| Emblem | Essential Plan 1 & 2 | $131 |
| HealthFirst | Essential Plan 3 & 4 | $316 |
| MetroPlus | Default Duals | $390 |
| MetroPlus | Medicaid Advantage Plus | $390 |
| MetroPlus | Medicare Advantage | $390 |
| Emblem | Medicare | $435 |
| Fidelis | Medicare | $435 |
| HealthFirst | IB Dual Connection HMO D-SNP | $435 |
| HealthFirst | Medicare PPO | $435 |
| Point Comfort | Indemnity | $435 |
| UHC | Medicare | $435 |
| VillageCareMAX | Medicare | $435 |
| VNSNY Choice | Medicare | $435 |
| Anthem Healthplus | Medicare | $435 |
| Wellcare | Medicare | $444 |
| Elderplan | Medicare | $449 |
| Centerlight | PACE | $449 |
| Partners Health Plan | FIDA IDD | $457 |
| Longevity | Medicare Advantage SNP Plan | $475 |
| Humana | Humana | $479 |
| Centerlight | Medicare | $479 |
| Emblem | Select Care | $523 |
| MetroPlus | Exchange Products | $566 |
| Molina Healthcare of NY Affinity | Essential Plan 1 & 2 | $601 |
| Molina Healthcare of NY Affinity | Essential Plan 200-250 | $601 |
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