CT abdomen and pelvis with contrast at Providence Mission Hospital - Mission Viejo. CPT 74177.
What Providence Mission Hospital - Mission Viejo publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$2,006cash price (self-pay)
$4,515list price
$381–$3,199range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Providence | Oscar All Commercial Plans | $381 |
| Aetna | Medicare Managed Care Plan | $449 |
| Blue Cross | Anthem Vivity City Of La Other Commercial Plan | $470 |
| Blue Cross | Anthem Vivity Non City Of La Other Commercial Plan | $529 |
| Unitedhealthcare | All Commercial Plans | $611 |
| Unitedhealthcare | Select/Navigate Hmo | $611 |
| Healthnet | Ambetter Hmo | $830 |
| Aetna | Gatekeeper Hmo | $1,436 |
| Blue Cross | Anthem Non-Mcs (Ind1, Ncx1, Ncx3) All Commercial Plans | $2,666 |
| Blue Cross | Anthem Mcs (Indx) All Commercial Plans | $3,199 |
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All common services at Providence Mission Hospital - Mission Viejo