CT abdomen and pelvis with contrast at Fairview Hospital. CPT 74177.
What Fairview Hospital publishes for this service, straight from its standard-charges file, last updated March 25, 2026.
Outpatient / ER
$3,170cash price (self-pay)
$4,385list price
$109–$5,161range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Other Government | Tri Tricare | $783 |
| Medicare | MCR Traditional Medicare | $794 |
| Medicare | MCRManaged Medicare HMO | $794 |
| Fallon | MCRManaged Fallon Medicare Advantage | $802 |
| Fallon | MCRManaged Fallon Medicare SCO | $805 |
| Hospice | Comm Hospice | $807 |
| Other Government | MCR Miscellaneous | $807 |
| Other Government | MCRManaged USA Family | $807 |
| Other Government | MCRManaged VA | $807 |
| United Healthcare | Oth United VACCN | $807 |
| Health New England | MCRManaged HNE Medicare Advantage | $815 |
| Blue Cross | MCRManaged Blue Cross VT Medicare HMO | $817 |
| CommCare Alliance | MCRManaged CCA One Care | $822 |
| Point32Health | Comm Tufts QHPSUB (Network) | $1,080 |
| Point32Health | MCDManaged Tufts (Network) | $1,080 |
| Comm Fallon QHP | Comm Fallon QHP | $1,262 |
| Aetna | Comm Aetna | $1,383 |
| Comm HNE HMO | Comm HNE HMO | $1,402 |
| Unicare | Comm Wellpoint (Unicare) | $1,421 |
| Health New England | Comm HNE | $1,484 |
| Comm HNE PPO | Comm HNE PPO | $1,489 |
| Fallon | MCDManaged Fallon Medicaid ACO | $1,793 |
| Allways NHP | Comm NHP | $2,837 |
| United Healthcare | Comm United BH | $2,850 |
| Point32Health | Comm Tufts QHPNONSUB (Network) | $2,938 |
| Blue Cross | Comm Blue Cross VT PPO | $3,374 |
| Point32Health | Comm Tufts | $3,473 |
| United Healthcare | Comm UnitedHealthcare | $3,771 |
| Capital District Physicians' Health Plan | Comm CDPHP | $3,946 |
| Cigna | Comm Cigna Carelink | $3,946 |
Inpatient
$5,161cash price (self-pay)
$5,433list price
$3,069–$5,161range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Point32Health | Comm Tufts QHPSUB (Network) | $3,069 |
| Point32Health | MCDManaged Tufts (Network) | $3,069 |
| Workers Comp | WC Workers Comp | $3,463 |
| Allways NHP | Comm NHP | $3,515 |
| Point32Health | Comm Tufts QHPNONSUB (Network) | $3,520 |
| United Healthcare | Comm United BH | $3,531 |
| Blue Cross | Comm Blue Cross VT PPO | $3,911 |
| Aetna | Comm Aetna | $4,102 |
| Point32Health | Comm Tufts | $4,303 |
| United Healthcare | Comm UnitedHealthcare | $4,672 |
| Capital District Physicians' Health Plan | Comm CDPHP | $4,889 |
| MVP | Comm MVP | $4,889 |
| Oxford | Comm Oxford | $4,889 |
| Connecticare | Comm Connecticare | $5,161 |
| Consolidated Health Plans | Comm Consolidated Health | $5,161 |
| First Health | Comm First Health | $5,161 |
| Point32Health | Comm Harvard | $5,161 |
| Other Commercial | Comm Other | $5,161 |
| PHCS | Comm PHCS | $5,161 |
| Self Pay | Comm Self Pay | $5,161 |
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