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 June 15, 2026.
Outpatient / ER
$1,602cash price (self-pay)
$2,464list price
$0.87–$2,464range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| AETNA | Acop | $0.87 |
| AETNA | Asa_Whirlpool_Peia | $1.01 |
| Aetna | Medicare Advantage | $330 |
| Anthem | Medicare Advantage | $330 |
| Devoted Health | Medicare Advantage | $330 |
| MMO | Medicare Advantage HMO | $331 |
| OPTUM | Medicare Advantage Transplant | $331 |
| HUMANA | Medicare Advantage HMO | $334 |
| Cigna | Medicare Advantage | $340 |
| MMO | Medicare Advantage PPO | $341 |
| CommuniCare | MEDICARE ADVANTAGE | $347 |
| ANTHEM | Managed Medicaid | $357 |
| Buckeye | Managed Medicaid | $357 |
| MOLINA | Managed Medicaid | $357 |
| CARESOURCE | Managed Medicaid | $363 |
| AMERIHEALTH | Managed Medicaid | $374 |
| Anthem | Hpn | $558 |
| Cc Ehp | All Products | $833 |
| Anthem | PPO/HMO | $952 |
| Mmo | All Products | $958 |
| Aultcare | PPO/HMO | $1,027 |
| Amish Community Aid Plan | ALL PRODUCTS | $1,109 |
| Ohcp | All Products | $1,198 |
| Omas | All Products | $1,232 |
| Mmo | Traditional | $1,284 |
| Mmo | Nasco | $1,284 |
| Ohio Healthy | TRANSPLANT | $1,331 |
| Healthsmart | All Products | $1,355 |
| Anthem | Traditional | $1,376 |
| AETNA | International | $1,563 |
Inpatient
$1,602cash price (self-pay)
$2,464list price
$697–$2,464range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Oscar | All Products | $889 |
| Amish Community Aid Plan | ALL PRODUCTS | $1,232 |
| Anthem | Traditional | $1,420 |
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