CT abdomen and pelvis with contrast at Fairfield Hospital District. CPT 74177.
What Fairfield Hospital District publishes for this service, straight from its standard-charges file, last updated April 28, 2026.
Outpatient / ER
$5,155cash price (self-pay)
$7,365list price
$262–$3,682range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| United Community Medicaid | Medicaid | $262 |
| Medicare Advantage Plans | Medicare | $349 |
| Medicare | Medicare | $349 |
| BCBS Blue Advantage HMO | HMO | $431 |
| 90 Degrees Benefits | PPO | $523 |
| Aetna Commercial | PPO | $579 |
| United Healthcare Commercial | PPO | $726 |
| BCBS Blue Essentials | HMO | $1,581 |
| BCBS Blue Traditional/PPO/POS | PPO | $1,737 |
| Curative | PPO | $3,682 |
Inpatient
$5,155cash price (self-pay)
$7,365list price
$579–$3,682range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna Commercial | PPO | $579 |
| Curative | PPO | $3,682 |
| BCBS Blue Traditional/PPO/POS | PPO | $3,682 |
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