CT abdomen and pelvis with contrast at La Palma Intercommunity Hospital. CPT 74177.
What La Palma Intercommunity Hospital publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$446cash price (self-pay)
$3,833list price
$203–$3,833range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Shield Of Promise | Blue Shield Of Promise Medi-Cal | $203 |
| Caloptima | Caloptima Medi-Cal IP | $203 |
| COUNTY OF ORANGE (MSN) | COUNTY OF ORANGE (MSN) Medi-Cal | $203 |
| LA Care Health Plan | L.A Care Health Plan Medi-Cal | $203 |
| Molina | Molina Medi-Cal | $203 |
| Traditional Medi - Cal | Traditional Medi-Cal | $203 |
| Health Net of CA | Health Net Of CA Medi-Cal | $217 |
| Anthem Blue Cross | Anthem Blue Cross Medi-Cal | $296 |
| Blue Shield Of Promise | Blue Shield Of Promise Medicare | $447 |
| Blue Shiled Of CA Triwest | Blue Shield of CA TriWest Healthcare VA | $447 |
| Health Net Federal Services Tricare | Health Net Federal Services Tric | $447 |
| Health Net of CA | Health Net Of CA Medicare | $447 |
| LA Care Health Plan | L.A Care Health Plan Covered Direct | $447 |
| LA Care Health Plan | L.A Care Health Plan Duals | $447 |
| Managed Health Network | Managed Health Network Medicare | $447 |
| Molina | Molina Exchange | $447 |
| Molina | Molina Medicare | $447 |
| Renal Payer Solutions | Renal Payor Solutions Medicare | $447 |
| Traditional Medicare | Traditional Medicare | $447 |
| Tricare | Tricare | $447 |
| Verda HealthPlan | Verda HealthPlan Medicare | $447 |
| Brand New Day | Brand New Day Medicare | $451 |
| Imperial Health Plan Of CA | Imperial Health Plan Of CA Medicare | $473 |
| COVENTRY fka AETNA Worker Comp | COVENTRY - fka AETNA - Workers Compen | $571 |
| CA FOUNDATION FOR MEDICAL CARE | CA FOUNDATION FOR MEDICAL CARE Worker | $588 |
| Workers Compensation | Workers Compensation | $588 |
| Employer Direct Healthcare | Employer Direct Healthcare Surgery Plus | $625 |
| Health Net of CA | Health Net Of CA Commercial PPO | $628 |
| Health Net of CA | Health Net Of CA Commercial Ins Exchange | $652 |
| Brand New Day | Brand New Day Exchange | $670 |
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