CT abdomen and pelvis with contrast at Aurelia Osborn Fox Memorial Hospital. CPT 74177.
What Aurelia Osborn Fox Memorial Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$1,579cash price (self-pay)
$5,847list price
$65.41–$6,823range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Emblem | Managed Medicaid | $65.41 |
| Fidelis | Managed Medicaid | $65.41 |
| Mvp | Managed Medicaid | $67.70 |
| Cdphp | Managed Medicaid | $109 |
| Mvp | Managed Medicaid Essential | $234 |
| Cdphp | Essentials | $245 |
| Aetna | Medicare Advantage | $453 |
| BCBS | Anthem Medicare Advantage | $453 |
| BCBS | Excellus Blue HMO | $453 |
| BCBS | Excellus Blue Medicare Advantage | $453 |
| BCBS | Excellus Blue PPO | $453 |
| BCBS | Excellus Exchange | $453 |
| BCBS | Excellus HMO Blue Option Managed Medicaid | $453 |
| BCBS | Excellus Utica | $453 |
| BCBS | Highmark | $453 |
| BCBS | Highmark Medicare Advantage | $453 |
| Cdphp | Medicare Advantage | $453 |
| Emblem | Medicare Advantage | $453 |
| Fidelis | Medicare Advantage | $453 |
| Fidelis | Medicare Advantage Flex | $453 |
| Humana | Medicare Advantage | $453 |
| Mvp | Medicare Advantage | $453 |
| United Healthcare | Madicare Advantage | $453 |
| BCBS | Anthem Exchange | $5,438 |
| BCBS | Empire | $5,438 |
| BCBS | Empire Exchange | $5,438 |
| BCBS | Empire Healthchoice | $5,438 |
| BCBS | Empire Managed Medicaid | $5,438 |
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