CT abdomen and pelvis with contrast at Dominican Hospital. CPT 74177.
What Dominican Hospital publishes for this service, straight from its standard-charges file, last updated February 28, 2026.
Outpatient / ER
$8,879cash price (self-pay)
$19,732list price
$282–$16,772range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| BCBS - Anthem | Medicaid|All Plans | $282 |
| COSC Psych | Medicaid|All Plans | $282 |
| Central California Alliance for Health | Medicaid|All Plans | $282 |
| Health Net | Medicaid|< 21 | $426 |
| Health Net | Medicaid|> 21 | $426 |
| Blue Shield CA | Medicare|All Plans | $491 |
| Health Net | Medicare|All Plans | $491 |
| Kaiser | Medicare|All Plans | $491 |
| United | Medicare|All Plans | $491 |
| Blue Shield CA | Commercial|DHMF | $559 |
| United | Commercial|All Other Plans | $828 |
| United | Commercial|HMO | $828 |
| United | Commercial|Non-Options PPO | $828 |
| United | Commercial|Options PPO | $828 |
| Sutter Health | Commercial|All Plans | $1,536 |
| Cigna | Commercial|LocalPlus | $2,468 |
| Cigna | Commercial|All Other Plans | $2,625 |
| BCBS - Anthem | Commercial|All Other Plans | $2,792 |
| Aetna | Commercial|HMO | $3,000 |
| Aetna | Commercial|PPO | $3,000 |
| BCBS - Anthem | Commercial|MCS | $3,900 |
| Kaiser | Commercial|All Plans | $12,826 |
| Western Growers | Commercial|All Plans | $13,812 |
| Healthsmart | Commercial|All Plans | $15,786 |
| First Health | Commercial|All Plans | $16,772 |
| Multiplan | Commercial|All Plans | $16,772 |
Inpatient
$8,879cash price (self-pay)
$19,732list price
$15,786–$16,772range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Healthsmart | Commercial|All Plans | $15,786 |
| First Health | Commercial|All Plans | $16,772 |
| Multiplan | Commercial|All Plans | $16,772 |
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