CT abdomen and pelvis with contrast at Avita Ontario Hospital. CPT 74177.
What Avita Ontario Hospital publishes for this service, straight from its standard-charges file, last updated March 23, 2026.
Outpatient / ER
$3,980cash price (self-pay)
$4,682list price
$123–$5,629range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medical_Mutual | Commercial | $123 |
| Caresource | Medicaid_Outpatient | $664 |
| Traditional_Medicaid | Outpatient | $664 |
| Molina | Medicaid_Outpatient | $664 |
| OhioRise | Medicaid_Outpatient | $664 |
| United_HealthCare | Medicaid_Outpatient | $664 |
| Anthem | Medicaid_Outpatient | $684 |
| AmeriHealth | Medicaid_Outpatient | $698 |
| Buckeye | Medicaid_Outpatient | $719 |
| Humana_Horizons | Medicaid_Outpatient | $719 |
| Aetna | Medicare_Outpatient | $728 |
| Anthem | Medicare_Outpatient | $728 |
| Buckeye | Medicare_Outpatient | $728 |
| Humana | Medicare_Outpatient | $728 |
| Traditional_Medicare | Outpatient | $728 |
| Mount_Carmel | Medicare_Outpatient | $728 |
| Molina | Medicare_Outpatient | $728 |
| United_HealthCare | Medicare_Outpatient | $728 |
| Medical_Mutual | Medicare_Outpatient | $742 |
| Molina | Marketplace_Outpatient | $2,397 |
| Anthem | Traditional_Blue_Access_Blue_Preferred | $2,833 |
| Anthem | Blue_Access_I-II_Enhanced_Choice_Pathway_X | $2,856 |
| Anthem | Pathway_Group_HMO_Pathway_X | $3,104 |
| Anthem | Blue_Access_Blue_Preferred | $3,386 |
| Anthem | Medicare_Inpatient | $3,518 |
| Buckeye | Medicare_Inpatient | $3,518 |
| Humana | Medicare_Inpatient | $3,518 |
| Traditional_Medicare | Inpatient | $3,518 |
| Mount_Carmel | Medicare_Inpatient | $3,518 |
| Molina | Medicare_Inpatient | $3,518 |
Billed more than this?
Scan my billSnap a photo of your bill. We compare every line with these prices and coding rules, free.