CT abdomen and pelvis with contrast at San Gabriel Valley Medical Center. CPT 74177.
What San Gabriel Valley Medical Center publishes for this service, straight from its standard-charges file, last updated July 1, 2026.
Outpatient / ER
$966cash price (self-pay)
$4,967list price
$88.52–$4,967range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Cross Medi-Cal Managed Care | Blue Cross Medi-Cal | $88.52 |
| Facey Medical | Facey Medical | $240 |
| AIDS Healthcare Foundation | AIDS Hlth Fndn/Positive Hlth Mcal | $282 |
| AltaMed Health Network | AltaMed Health Network Medi-Cal | $282 |
| Avanti | Avanti Medi-cal | $282 |
| Beverly Hospital | BEVERLY HOSPITAL MCL | $282 |
| Emanate Health | Emanate Health Medi-Cal | $282 |
| HealthNet Medi-Cal Non-Contract | Health Net Medi-Cal | $282 |
| Healthy Way LA | Healthy Way LA | $282 |
| Hollywood Presbyterian Adv Med Mcal | Hollywood Presbyterian Adv Med M | $282 |
| Hollywood Presbyterian Medpoint Mcal | Hollywood Presbyterian Medpoint | $282 |
| Medi-Cal/Medicaid | Medi-Cal/Medicaid | $282 |
| Blue Cross Medi-Cal Managed Care | Blue Cross Healthy Families | $310 |
| LA Care Health Plan | LA Care Healthy Kids and Medi-Cal Managed Care | $324 |
| AHMC Medi-Cal Reciprocity | AHMC Medi-Cal Reciprocity | $355 |
| AHMC Reciprocity | AHMC Reciprocity Commercial | $355 |
| AHMC Reciprocity | AHMC Reciprocity Sr | $355 |
| Aetna Health of California | Aetna | $378 |
| United Healthcare Senior Medicare Advantage | United Healthcare Senior | $389 |
| Care 1st Health Plan | BLUE SHIELD PROMISE HEALTH PLAN MCAL | $395 |
| Molina Healthcare of California | Molina Medi-Cal | $450 |
| Care 1st Health Plan | BLUE SHIELD PROMISE HEALTH HMO | $500 |
| Care 1st Health Plan | BLUE SHIELD PROMISE HEALTH SENIOR | $500 |
| Blue Cross of CA | Blue Cross of CA | $989 |
| Central Health Plan | Central Health Plan HMO | $1,000 |
| Care 1st Health Plan | Care 1st Health Plan Healthy Families | $1,242 |
| Cigna Healthcare | Cigna HMO/PPO/Open Access/Network | $1,550 |
| AIDS Healthcare Foundation | AIDS Healthcare Foundation | $1,800 |
| Health Net | Health Net Enhanced PPO | $2,394 |
| Blue Shield of California | Blue Shield Value Network Covered Californ | $2,713 |
Inpatient
$966cash price (self-pay)
$4,967list price
$2,577–$4,967range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Beech Street | Beech Street PPO | $3,974 |
| MultiPlan | MultiPlan PPO | $4,470 |
| PPO Next | PPO Next | $4,470 |
| Other Non Contracted Commercial | Other Non Contracted Commercial | $4,967 |
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