CT abdomen and pelvis with contrast at Ascension Via Christi Rehabilitation Hospital. CPT 74177.
What Ascension Via Christi Rehabilitation Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
—cash price (self-pay)
—list price
$277–$1,033range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Default - 100 Percent Of Medicare Rates | 1016_default - 100 Percent O | $330 |
| Medicare Advantage Coventry | 1339_medicare Advantage Coventry Outpati | $330 |
| Medicare Advantage Humana | 1340_medicare Advantage Humana Outpatient | $330 |
| Medicare Advantage Other | 1341_medicare Advantage Other Outpatient 20 | $330 |
| Va | 1015_veterans Outpatient 20230101 | $330 |
| Vc Hope | 1342_medicare Advantage Vc Hope Outpatient 20250101 | $330 |
| Aarp Medicare Replacement | 1336_medicare Advantage Aarp Outpatient 20 | $334 |
| Allwell Medicare | 1337_medicare Advantage Allwell Outpatient 20250101 | $337 |
| Medicare Advantage Blue Cross Blue Shield | 1338_medicare Advantage Bl | $337 |
| Medicare Advantage UHC | 1343_rhks Medicare Advantage United Healthcar | $337 |
| Smarthealth | 1083_smarthealth Outpatient 20230101 | $462 |
| Ambetter Sunflower | 1003_ambetter Sunflower Outpatient 20230101 | $561 |
| Aetna | 1369_aetna Rhks 20241101 | $756 |
| Cigna | 1446_cigna Rhks 20250501 | $803 |
| Aetna: City Of Wichita | 643_aetna City Of Wichita Stks, Vwks 20200415 | $912 |
| United Healthcare Exchange | 1479_rhks United Healthcare Exchange Outp | $925 |
Inpatient
—cash price (self-pay)
—list price
$330–$925range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Default - 100 Percent Of Medicare Rates | 1490_default - 100 Percent O | $330 |
| Medicare Advantage Humana | 1499_medicare Advantage Humana Inpatient R | $330 |
| Medicare Advantage Other | 1501_medicare Advantage Other Inpatient Stk | $330 |
| Va | 1492_veterans Inpatient 20251001 | $330 |
| Vc Hope | 1502_medicare Advantage Vc Hope Inpatient 20251001 | $330 |
| Aarp Medicare Replacement | 1507_medicare Advantage Aarp Inpatient 202 | $334 |
| Medicare Advantage Coventry | 1500_medicare Advantage Coventry Inpatie | $334 |
| Allwell Medicare | 1497_medicare Advantage Allwell Inpatient 20251001 | $337 |
| Medicare Advantage Blue Cross Blue Shield | 1498_medicare Advantage Bl | $337 |
| Medicare Advantage UHC | 1509_rhks Medicare Advantage United Healthcar | $337 |
| Smarthealth | 1489_smarthealth Inpatient 20251001 | $462 |
| Ambetter Sunflower | 1491_ambetter Sunflower Inpatient 20251001 | $561 |
| United Healthcare Exchange | 1518_rhks United Healthcare Exchange Inpa | $925 |
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All common services at Ascension Via Christi Rehabilitation Hospital