CT abdomen and pelvis with contrast at M Health Fairview Ridges Hospital. CPT 74177.
What M Health Fairview Ridges Hospital publishes for this service, straight from its standard-charges file, last updated February 6, 2026.
Outpatient / ER
$132cash price (self-pay)
$1,813list price
$59.12–$1,649range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Cross of Minnesota | PMAP | $203 |
| Itasca Medical Care | Managed Medicaid | $336 |
| Primewest | Managed Medicaid | $336 |
| South Country Health Alliance | PMAP | $336 |
| Itasca Medical Care | Medicare Advantage/MSHO | $347 |
| Primewest | MSHO | $347 |
| Sanford Health Plan | Medicare Advantage | $347 |
| Security Health Plan | Medicare Advantage | $347 |
| South Country Health Alliance | Medicare Advantage | $347 |
| United Healthcare | Medicare Advantage | $347 |
| WellCare | Medicare Advantage | $347 |
| UCare | Medicare Advantage/MSHO | $353 |
| Blue Cross of Minnesota | Medicare Advantage | $361 |
| Hennepin Health | PMAP | $363 |
| UCare | PMAP | $364 |
| Health Partners | Medicare Advantage | $368 |
| Medica | Medicare Advantage Non-SNP | $368 |
| Health Partners | Medicare Cost | $413 |
| Health Partners | PMAP | $420 |
| Blue Cross of Minnesota | Aware Federal | $480 |
| Blue Cross of Minnesota | Aware/Blue Plus | $488 |
| Medica | Managed Medicaid/AccessAbility | $501 |
| Medica | MSHO/Medicare Advantage SNP | $541 |
| United Healthcare | Commercial | $593 |
| United Healthcare | Core | $593 |
| UCare | Individual and Family with M Health Fairview | $618 |
| Medica | Bold | $731 |
| Medica | City of St. Paul/Essential-Uplan | $757 |
| Medica | Vantage Self Insured | $792 |
| UCare | Individual and Family | $798 |
Inpatient
$643cash price (self-pay)
$1,823list price
$788–$1,649range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| America's PPO | EZCare | $950 |
| Sanford Health Plan | Commercial | $1,074 |
| America's PPO | Health EZ | $1,075 |
| America's PPO | Commercial | $1,165 |
| Security Health Plan | Commercial | $1,367 |
| First Health | Commercial | $1,495 |
| MultiPlan | Commercial | $1,549 |
| Private Healthcare Systems | Commercial | $1,549 |
| Wisconsin Physician Services | Commercial | $1,640 |
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