CT abdomen and pelvis with contrast at Mosaic Medical Center Albany. CPT 74177.
What Mosaic Medical Center Albany publishes for this service, straight from its standard-charges file, last updated September 26, 2025.
Outpatient / ER
$2,125cash price (self-pay)
$2,500list price
$81.78–$2,850range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Amerigroup of Iowa | Managed Medicaid | $225 |
| Iowa Total Care | Managed Medicaid | $225 |
| Molina of Iowa | Managed Medicaid | $225 |
| Blue Cross PC | Commercial | $271 |
| Freedom Select Healthlink | Commercial | $271 |
| Blue Cross PCB | Commercial | $271 |
| Sisco | Commercial | $271 |
| Aetna | Medicare Advantage | $1,082 |
| Generic | Medicare Advantage | $1,082 |
| Blue Cross Blue Shield | Medicare Advantage | $1,082 |
| United Healthcare | Medicare Advantage | $1,082 |
| Aetna | Commercial | $1,209 |
| Ambetter | Commercial | $1,623 |
| Centurion | Commercial | $1,750 |
| Cigna | Commercial | $1,853 |
| Humana | Medicare Advantage | $1,900 |
| Coventry | Commercial | $2,125 |
| Healthlink Open Access | Commercial | $2,125 |
| Multiplan | Commercial | $2,125 |
| Preferred Health Professional | Commercial | $2,125 |
| GEHA Shared Services | Commercial | $2,165 |
| United Healthcare | Commercial | $2,165 |
| Healthy Blue of Missouri | Managed Medicaid | $2,750 |
| Home State of Missouri | Commercial | $2,750 |
| United Healthcare of Missouri | Managed Medicaid | $2,750 |
Inpatient
$2,125cash price (self-pay)
$2,500list price
$1,000–$2,250range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Centurion | Commercial | $1,000 |
| Cigna | Commercial | $1,853 |
| Sisco | Commercial | $1,853 |
| Blue Cross PCB | Commercial | $1,930 |
| Healthlink Open Access | Commercial | $2,125 |
| Multiplan | Commercial | $2,125 |
| Blue Cross PC | Commercial | $2,125 |
| Freedom Select Healthlink | Commercial | $2,125 |
| Preferred Health Professional | Commercial | $2,125 |
| Aetna | Commercial | $2,128 |
| GEHA Shared Services | Commercial | $2,165 |
| United Healthcare | Commercial | $2,165 |
| Coventry | Commercial | $2,250 |
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