CT abdomen and pelvis with contrast at San Dimas Community Hospital. CPT 74177.
What San Dimas Community Hospital publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$446cash price (self-pay)
$9,567list price
$203–$9,567range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| AIDS Healthcare Foundation | Aids Health Care Foundation Medi-cal | $203 |
| Blue Shield of Promise | Blue Shield Of Promise Medi-Cal | $203 |
| Heritage Provider Network Inc | Heritage Provider Network Medi-Cal | $203 |
| LA Care Health Plan | L A Care Health Plan Medi-cal | $203 |
| Anthem Blue Cross | Anthem Blue Cross Medi-Cal | $213 |
| Health Net of CA | Health Net Of CA Medi-Cal | $217 |
| AIDS Healthcare Foundation | Aids Health Care Foundation MSSP | $447 |
| Anthem Blue Cross | Anthem Blue Cross Medicare | $447 |
| Blue Shield of CA | Blue Sheild Of CA Medicare | $447 |
| Blue Shield of CA | Blue Shield Of CA Triwest | $447 |
| Central Health Plan | Central Health Plan Medicare | $447 |
| Choice Physicians Network | Choice Physicians Network Medicare | $447 |
| Citrus Valley Physicians Group | Citrus Valley Physicians Group Commer | $447 |
| Citrus Valley Physicians Group | Citrus Valley Physicians Group Medi-c | $447 |
| Citrus Valley Physicians Group | Citrus Valley Physicians Group Medica | $447 |
| Elite Health Plan | Elite Health Plan (Medicare) | $447 |
| Health Excel Inc | Health Excel Inc Medicare | $447 |
| Health Net of CA | Health Net Federal Services Tricare | $447 |
| Health Net of CA | Health Net Of CA Cal Mediconnect | $447 |
| Health Net of CA | Health Net Of CA Medicare | $447 |
| Heritage Provider Network Inc | Heritage Provider Network Medicare | $447 |
| LA Care Health Plan | LA Care Health Plan Covered CA and Covered Direc | $447 |
| LA Care Health Plan | LA Care Health Plan Duals Cal MediConnect | $447 |
| LA Care Health Plan | LA Care Health Plan Medicare | $447 |
| Molina Healthcare | Molina Exchange | $447 |
| Brand New Day | Brand New Day Medicare | $451 |
| AIDS Healthcare Foundation | Aids Health Care Foundation Medicare | $455 |
| Imperial Health Plan Inc | Imperial Health Plan Medicare | $473 |
| Anthem Blue Cross | Anthem Blue Cross Workers Compensation | $500 |
| Heritage Provider Network Inc | Heritage Provider Network Commercial I | $558 |
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