CT abdomen and pelvis with contrast at Allina Health Faribault Medical Center. CPT 74177.
What Allina Health Faribault Medical Center publishes for this service, straight from its standard-charges file, last updated June 16, 2026.
Outpatient / ER
$1,825cash price (self-pay)
$3,259list price
$318–$3,259range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Cross Blue Shield | BC PMAP (B D O S V) | $318 |
| All Other Medicaid (V) | All Other Medicaid (V) | $332 |
| Medicaid MA | Medicaid MA (V) | $332 |
| Allina Aetna Medicare (V) | Allina Aetna Medicare (V) | $342 |
| South Country Health Alliance | SCHA PMAP (V) | $342 |
| Medicare Other | All Other Medicare (V) | $357 |
| Medicare | Medicare (V) | $360 |
| Medica Medicare | Medica Medicare (V) | $374 |
| BCBS | BC Medicare (V) | $375 |
| Scha Msho (V) | Scha Msho (V) | $393 |
| Medica Health System | Medica Dual Solutions (B D V O S) | $574 |
| HealthPartners | HPI (BDOV) | $651 |
| Blue Cross | Allina Health BluePrint (BDOSHV) | $652 |
| UCare PMAP (A B C D E G N O S U R H) | UCare PMAP (ABDMNORSUV) | $656 |
| Blue Cross Blue Shield | BC State Health Plan (B D O S V) | $662 |
| Health Partners | HPI Cigna (BDOV) | $709 |
| Blue Cross Blue Shield of Minnesota | BC Premier (B D O S V) | $738 |
| Blue Cross Blue Shield | BC AEHP (B D O S V) | $868 |
| Blue Cross Blue Shield of Minnesota | BC High Value/Performance Networ | $932 |
| Blue Cross Blue Shield | BC AWARE/Blue Plus (B D O S V) | $981 |
| Medica Health System | Medica Elect (B D O S V) | $992 |
| Medica | Medica Essentials (B D O S V) | $1,036 |
| Medica MHPS | Medica MHPS (BDOSV) | $1,036 |
| Medica Health System | Medica Choice (B D O S V) | $1,090 |
| United HealthCare (BDOHSV) | United Healthcare (BDOSV) | $1,364 |
| Aetna | Aetna Elevate (BDOSV) | $1,452 |
| Aetna | Aetna Performance (BDOSV) | $1,533 |
| Aetna Direct/Indirect Regional Network | Aetna Direct/Indirect Regiona | $1,937 |
| Americas PPO (Araz)(B D N O R S V) | Americas PPO (Araz)(B D N O R S V | $2,514 |
| Americas PPO (Araz) (B D N H O R S) | Americas PPO (Araz) (B D N H O R | $2,737 |
Inpatient
$1,825cash price (self-pay)
$3,259list price
$1,448–$3,259range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna | Aetna Elevate (BDOSV) | $1,448 |
| Aetna | Aetna Performance (BDOSV) | $1,529 |
| Aetna Direct/Indirect Regional Network | Aetna Direct/Indirect Regiona | $1,932 |
| Americas PPO (Araz)(B D N O R S V) | Americas PPO (Araz)(B D N O R S V | $2,514 |
| Americas PPO (Araz) (B D N H O R S) | Americas PPO (Araz) (B D N H O R | $2,737 |
| First Health (A C E G H U B D N O R S) | First Health (ABDMNOSURV) | $2,737 |
| All Other Contracted Care (A B C D E G H N O R S U) | All Other Contra | $3,259 |
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All common services at Allina Health Faribault Medical Center