CT abdomen and pelvis with contrast at Mary Imogene Bassett Hospital. CPT 74177.
What Mary Imogene Bassett Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$265cash price (self-pay)
$3,676list price
$69.12–$6,823range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Mvp | Managed Medicaid | $69.12 |
| Fidelis | Managed Medicaid | $70.72 |
| BCBS | Excellus Child Health Plus Managed Medicaid | $72.18 |
| BCBS | Excellus Essential Managed Medicaid | $72.18 |
| BCBS | Excellus Healthy NY EPO Managed Medicaid | $72.18 |
| BCBS | Excellus Healthy NY Managed Medicaid | $72.18 |
| BCBS | Excellus Safety Net | $72.18 |
| BCBS | Excellus Blue Medicare Advantage PPO | $81.50 |
| BCBS | Excellus Medicare Advantage HMO/POS | $81.50 |
| BCBS | Excellus Medicare Advantage PPO | $81.50 |
| BCBS | Excellus Sr Federal | $81.50 |
| Aetna | Medicare Advantage HMO | $83.95 |
| Aetna | Medicare Advantage PPO/EPO | $83.95 |
| Emblem | Managed Medicaid | $92.53 |
| Cdphp | Managed Medicaid | $93.22 |
| Aetna | Allied Benefit | $121 |
| Aetna | Signature | $121 |
| BCBS | Anthem | $128 |
| BCBS | Empire Healthchoice | $128 |
| BCBS | Empire Healthchoice HMO/PPO/POS | $128 |
| BCBS | Excellus | $132 |
| BCBS | Excellus Alliance | $132 |
| BCBS | Excellus Blue Card | $132 |
| BCBS | Excellus Exchange | $132 |
| BCBS | Excellus Federal | $132 |
| BCBS | Excellus HMO Blue Access | $132 |
| BCBS | Excellus PPO/EPO | $132 |
| BCBS | Excellus Preferred PPO | $132 |
| BCBS | Highmark HMO | $136 |
| BCBS | Empire | $137 |
Inpatient
$265cash price (self-pay)
$530list price
$70.54–$477range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| BCBS | Excellus Child Health Plus Managed Medicaid | $72.18 |
| BCBS | Excellus Essential Managed Medicaid | $72.18 |
| BCBS | Excellus Healthy NY EPO Managed Medicaid | $72.18 |
| BCBS | Excellus Healthy NY Managed Medicaid | $72.18 |
| BCBS | Excellus HMO Blue Option Managed Medicaid | $72.18 |
| BCBS | Excellus Safety Net | $72.18 |
| Cdphp | Child Health Plus | $77.43 |
| Cdphp | Managed Medicaid | $77.43 |
| BCBS | Anthem Medicare Advantage | $81.50 |
| BCBS | Excellus Blue Medicare Advantage | $81.50 |
| BCBS | Excellus Blue Medicare Advantage PPO | $81.50 |
| BCBS | Excellus Medicare Advantage HMO/POS | $81.50 |
| BCBS | Excellus Medicare Advantage PPO | $81.50 |
| BCBS | Excellus Sr Federal | $81.50 |
| BCBS | Highmark Medicare Advantage | $81.50 |
| Cdphp | Medicare Advantage HMO | $81.50 |
| Cdphp | Medicare Advantage PPO | $81.50 |
| Aetna | Medicare Advantage HMO | $83.95 |
| Aetna | Medicare Advantage PPO/EPO | $83.95 |
| Cdphp | Essentials | $92.91 |
| BCBS | Empire Exchange | $115 |
| Aetna | Allied Benefit | $121 |
| Aetna | Signature | $121 |
| BCBS | Anthem | $128 |
| BCBS | Empire Healthchoice | $128 |
| BCBS | Empire Healthchoice HMO/PPO/POS | $128 |
| BCBS | Excellus | $132 |
| BCBS | Excellus Alliance | $132 |
| BCBS | Excellus Blue Card | $132 |
| BCBS | Excellus Exchange | $132 |
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