CT abdomen and pelvis with contrast at Saint Agnes Medical Center. CPT 74177.
What Saint Agnes Medical Center publishes for this service, straight from its standard-charges file, last updated March 31, 2026.
Outpatient / ER
$188cash price (self-pay)
$188list price
$53.46–$4,698range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Molina Medicare Advantage | Medicare | $83.46 |
| Rx Allwin | Medicare | $83.46 |
| Aetna Medicare Advantage | Aetna Medicare Advantage | $262 |
| Healthnet Medicare Advantage | Healthnet Medicare Advantage | $271 |
| Brand New Day Medicare Advantage | Brand New Day Medicare Advantage | $274 |
| Kaiser Permanente Medicare Advantage | Kaiser Medicare Advantage | $276 |
| Correctcare Integrated Health | Correct Care Integrated Health Medicai | $282 |
| Medi-Cal Healthnet | Health Net Medicaid | $305 |
| Medi-Cal Blue Cross | Anthem Medicaid | $324 |
| Medi-Cal Healthnet | Adventist Medicaid | $349 |
| Blue Cross - CA (Anthem) Medicare Advantage | Anthem BCBS Medicare Adv | $440 |
| Healthnet Medicare Advantage | Key Medical Group | $462 |
| Align Senior Care | Ally Senior Care Medicare Advantage | $516 |
| Blue Cross - CA (Anthem) Medicare Advantage | Anthem Medicare Adv Ipa | $528 |
| Aetna | Aetna | $642 |
| Kaiser Permanente | Kaiser HMO | $785 |
| Blue Cross - Mn | Anthem Bc HMO | $930 |
| Blue Cross - Va (Carefirst) | Anthem Bc HMO | $930 |
| Blue Cross - Va (Anthem) | Anthem Bc HMO | $930 |
| Blue Cross - TX | Anthem Bc HMO | $930 |
| Blue Cross - Tn | Anthem Bc HMO | $930 |
| Advantek Central Usd | Anthem Bc Advantek | $930 |
| Blue Cross - Ga (Anthem) | Anthem Bc HMO | $930 |
| Blue Cross - Co (Anthem) | Anthem Bc HMO | $930 |
| Blue Cross - Wa (Premera) | Blue Shield Commercial | $1,547 |
| Blue Cross - Vt | Blue Shield Commercial | $1,547 |
| Blue Cross - Ut (Regence) | Blue Shield Commercial | $1,547 |
| Blue Cross - Sc | Blue Shield Commercial | $1,547 |
| Blue Cross - Ri | Blue Shield Commercial | $1,547 |
| Blue Cross - Pa (Capital) | Blue Shield Commercial | $1,547 |
Inpatient
$216cash price (self-pay)
$216list price
$53.46–$216range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Illinicare Health Medicaid Advantage | Medicaid | $78.90 |
| Metroplus Medicaid Advantage | Medicaid | $78.90 |
| Blue Cross - Nj (Horizon) Medicaid Advantage | Medicaid | $78.90 |
| Green Mountain Medicaid Advantage | Medicaid | $78.90 |
| Pacificsource Health Plans Medicaid Advantage | Medicaid | $78.90 |
| Blue Cross - NY (Excellus) Medicaid Advantage | Medicaid | $78.90 |
| Carelon Health Medicaid | Medicaid | $78.90 |
| Medicaid Advantage Generic | Medicaid | $78.90 |
| Capital District Physicians Health Medicaid Advantage | Medicaid | $78.90 |
| Allwell Pa Health & Wellness Medicaid Advantage | Medicaid | $78.90 |
| Blue Cross - NY (Anthem) Medicaid Advantage | Medicaid | $78.90 |
| Community Benefit Health | Medicaid | $78.90 |
| Wc Zenith | Workers Comp | $78.90 |
| Wc Amerisure | Workers Comp | $78.90 |
| Wc Broadspire | Workers Comp | $78.90 |
| Wc Amtrust | Workers Comp | $78.90 |
| Geisinger Medicaid Advantage | Medicaid | $78.90 |
| Community Care Behavorial Health | Medicaid | $78.90 |
| La Care Health Plan | Medicaid | $78.90 |
| Molina Medicare Advantage | Medicare | $83.46 |
| Rx Allwin | Medicare | $83.46 |
| Huron Valley Pace | Medicare | $83.46 |
| Central Valley Medical Services Corp Pace | Medicare | $83.46 |
| Pace Cny | Medicare | $83.46 |
| American Health Plan | Medicare | $83.46 |
| Scan Health Plan Medicare Advantage | Medicare | $83.46 |
| Alignment Health Plan Medicare Advantage | Medicare | $83.46 |
| Sanford Health Plan Medicare Advantage | Medicare | $83.46 |
| Aetna Medicare Advantage | Aetna Medicare Advantage | $83.46 |
| Phoenix Medicare Advantage | Medicare | $83.46 |
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