CT abdomen and pelvis with contrast at Saint Alphonsus Medical Center-Ontario. CPT 74177.
What Saint Alphonsus Medical Center-Ontario publishes for this service, straight from its standard-charges file, last updated March 31, 2026.
Outpatient / ER
$2,813cash price (self-pay)
$4,328list price
$236–$4,198range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Benefit Administrators Of Massachusetts | Regence Bs | $1,093 |
| Blue Cross - Mt | Regence Bs | $1,093 |
| Blue Cross - Nv (Anthem) | Regence Bs | $1,093 |
| Blue Cross - Nh (Anthem) | Regence Bs | $1,093 |
| Blue Cross - Pa (Capital) | Regence Bs | $1,093 |
| Blue Shield - Pa (Highmark) | Regence Bs | $1,093 |
| Blue Cross - Ri | Regence Bs | $1,093 |
| Blue Cross - Sc | Regence Bs | $1,093 |
| Blue Shield - NY Highmark Western | Regence Bs | $1,093 |
| Blue Shield - NY Highmark Northeastern | Regence Bs | $1,093 |
| Blue Cross - Nc | Regence Bs | $1,093 |
| Blue Cross - Ok | Regence Bs | $1,093 |
| Blue Shield - CA | Regence Bs | $1,093 |
| Blue Cross - Co (Anthem) | Regence Bs | $1,093 |
| Blue Cross - Ct (Anthem) | Regence Bs | $1,093 |
| Blue Cross - De (Highmark) | Regence Bs | $1,093 |
| Blue Cross - Dc (Carefirst) | Regence Bs | $1,093 |
| Blue Cross - Ne | Regence Bs | $1,093 |
| Blue Cross - Oh (Anthem) | Regence Bs | $1,093 |
| Blue Cross - Sd (Wellmark) | Regence Bs | $1,093 |
| Blue Cross - Al | Regence Bs | $1,093 |
| Blue Cross - Ak (Premera) | Regence Bs | $1,093 |
| Blue Cross - Or (Regence) | Regence Bs | $1,093 |
| Blue Cross - Nj (Horizon) | Regence Bs | $1,093 |
| Blue Care Network | Regence Bs | $1,093 |
| Blue Cross - Nm | Regence Bs | $1,093 |
| Medicaid Pending | Medicaid | $1,298 |
| Medicaid - TX | Medicaid | $1,298 |
| Medi-Cal Blue Cross | Medicaid | $1,298 |
| Priority Health Medicaid | Medicaid | $1,298 |
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All common services at Saint Alphonsus Medical Center-Ontario