CT abdomen and pelvis with contrast at Fairview Park Hospital. CPT 74177.
What Fairview Park Hospital publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$15,781cash price (self-pay)
$15,781list price
$113–$14,203range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| BCBS | Hix | $307 |
| BCBS | Pathway | $307 |
| BCBS | HMO | $348 |
| BCBS | PPO | $373 |
| Peach State (Ambetter) | HIX | $421 |
| Core Resources | COMM | $424 |
| Health One Alliance | COMMHIX | $429 |
| Aetna | HMO | $460 |
| Aetna | OpenAccess | $460 |
| Aetna | POS | $460 |
| Aetna | PPO | $460 |
| Aetna | QualifiedHealthPlan | $460 |
| United | AllPayerAppendix | $828 |
| Prime Health | WORKERSCOMP | $898 |
| Employer's Health Network | WCOMP | $917 |
| Rockport United Network | WORKERSCOMP | $917 |
| Identity MCO | WorkersComp | $936 |
| Synergy Health Network | WorkersComp | $936 |
| Amerigroup | MCD | $2,115 |
| NHC Advantage | MGMCR | $2,998 |
| Pruitt Health | MCR | $2,998 |
| Peach State | MGMCD | $3,156 |
| Wellcare | MCD | $3,156 |
| Memorial Health Plan | EMPLOYEEPLAN | $3,472 |
| United | OptionsPPO | $3,898 |
| Americas 1st Choice | MCR | $4,419 |
| Leavitt Risk Partners | COMM | $4,734 |
| United | GlobalBenefitPlan | $7,101 |
| Dodge County Hospital | COMM | $7,891 |
| Aetna | NAP | $8,700 |
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