CT abdomen and pelvis with contrast at Franciscan Health Lafayette. CPT 74177.
What Franciscan Health Lafayette publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$777cash price (self-pay)
$3,515list price
$369–$3,515range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medicare [1099] | Medicare-Wir-Lafayette | $369 |
| Medicare Replacement [2003] | Medicare-Wir-Lafayette | $369 |
| Blue Cross [1014] | Anthem Blue Access PPO-Cid | $552 |
| Unicare [1150] | Anthem Blue Access PPO-Cid | $552 |
| Blue Cross Out Of State [1211] | Anthem Blue Access PPO-Cid | $552 |
| Alt Payer Indiana Blue Cross [121003] | Anthem Blue Access PPO-Cid | $552 |
| Medicaid Illinois [1091] | In Mcd-Wir-Lafayette | $632 |
| Medicaid [1092] | In Mcd-Wir-Lafayette | $632 |
| Mdwise [1175] | In Mcd-Wir-Lafayette | $632 |
| Alt Traditional Medicaid Secondary [109200] | In Mcd-Wir-Lafayette | $632 |
| Managed Health Services [1302] | In Mcd Lafayette Mhs 112% Of In Mcd | $652 |
| Workers Comp [1172] | Workers Comp - Wir - Lafayette | $738 |
| Medicaid [1092] | In Mcd Lafayet Caresource 120% Of In Mcd | $759 |
| Aetna [1005] | Aetna-Nid-Dyer-Munster-Crn Point | $846 |
| Managed Care [2000] | Aetna-Nid-Dyer-Munster-Crn Point | $846 |
| Blue Cross [1014] | Anthem Franciscan Employee Copps- All Locations | $893 |
| Blue Cross [1014] | Anthem Healthsync HMO With Copps - Lafayette | $1,079 |
| Blue Cross [1014] | Anthem Healthsync POS With Copps - Lafayette | $1,223 |
| Blue Cross [1014] | Anthem Blue Access PPO With Copps - Lafayette | $1,366 |
| Unicare [1150] | Anthem Blue Access PPO With Copps - Lafayette | $1,366 |
| Blue Cross Illinois [1210] | Anthem Blue Access PPO With Copps - Lafay | $1,366 |
| Blue Cross Out Of State [1211] | Anthem Blue Access PPO With Copps - L | $1,366 |
| Alt Payer Illinois Blue Cross [121002] | Anthem Blue Access PPO With C | $1,366 |
| Alt Payer Indiana Blue Cross [121003] | Anthem Blue Access PPO With Co | $1,366 |
| United Healthcare [1156] | United Healthcare Charter-Wid-Lafayette | $1,529 |
| Managed Care [2000] | Siho - Cid & Nid & Wid Locations | $1,658 |
| Managed Care [2000] | Encore - Cid & Nid & Wid & Sscd | $1,658 |
| Commercial [2001] | Encore - Cid & Nid & Wid & Sscd | $1,658 |
| United Healthcare [1156] | UHC All Payer-Wid-Lafayette | $1,698 |
| United Medical Resources [1158] | UHC All Payer-Wid-Lafayette | $1,698 |
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