CT abdomen and pelvis with contrast at White Plains Hospital. CPT 74177.
What White Plains Hospital publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
—cash price (self-pay)
$3,512list price
$109–$3,724range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Emblem | HIP_Medicaid FHP & CHP | $109 |
| Fidelis | CHP | $109 |
| Fidelis | Essential Plan - Aliessa | $109 |
| Emblem | HIP HMO | $218 |
| HealthFirst | Essential Plan 3 & 4 | $316 |
| Wellcare | Medicare | $401 |
| Aetna | Medicare | $431 |
| Emblem | Medicare | $435 |
| Fidelis | Medicare | $435 |
| Point Comfort | Point Comfort | $435 |
| Veterans Affair | Community Care | $435 |
| VillageCareMAX | Medicare | $435 |
| VNSNY Choice | Medicare | $435 |
| Anthem | Medicare | $435 |
| HealthFirst | Medicare | $435 |
| UHC | Medicare | $444 |
| Centerlight | PACE | $449 |
| Partners Health Plan | Partners Health | $457 |
| Elderplan | Medicare | $464 |
| Hamaspik | Medicare | $470 |
| Longevity | Medicare | $475 |
| Centerlight | Medicare | $479 |
| Humana | Medicare | $479 |
| Emblem | Select Care | $523 |
| Molina Healthcare of NY Affinity | Essential Plan 1 & 2 | $601 |
| Oscar | Commercial | $688 |
| Molina Healthcare of NY Affinity | Essential Plan 200-250 | $962 |
| Northwell | Northwell | $1,171 |
| UHC | Compass | $1,429 |
| UHC | Oxford | $1,429 |
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