CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Adventist Health White Memorial Montebello

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74177
Insurance Median: $454
Cash Discount Price: $454
vs. Medicare Baseline: 1.27x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Adventist Health White Memorial Montebello is $454. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $454. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 1.27x the Medicare baseline. Located in 309 W Beverly Blvd, Montebello, CA.

Cash / Self-Pay

$454

Average discount available for prompt cash payment at this facility.

Insurance Median

$454

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$356.43

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $356.43 (100%)

Cash / Self-Pay: $454 (127%)

Insurance Median: $454 (127%)

Cash: $454 (127% of Medicare)

Ins. Median: $454 (127% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $356.43 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Blue Shield Epn Core	$271	76%
Blue Shield Comm - All Other Plans	$281	79%
Healthcare Partners-All Plans	$334	94%
Altamed Mcal	$404	113%
Bc Mcal	$404	113%
Blue Shield Promise Mcal	$404	113%
Brand New Day Mcal	$404	113%
Healthnet Mcal	$404	113%
Kaiser Mcal	$404	113%
La Care Mcal	$404	113%
Medi-Cal	$404	113%
Molina Mcal - All Plans	$404	113%
Aetna	$442 - $454	124%
Alignment Health Plan-All Plans	$454	127%
Altamed Mcare-All Other Plans	$454	127%
Blue Shield Mcare Adv	$454	127%
Brand New Day Mcare-All Other Plans	$454	127%
Brandman Health Plan-All Plans	$454	127%
Caremore-All Plans	$454	127%
Clever Care Hp-All Plans	$454	127%
Easy Choice Mcare Adv-All Plans	$454	127%
Healthnet Med Adv	$454	127%
Kaiser Mcare Adv	$454	127%
Scan Health-All Plans	$454	127%
Oscar-All Plans	$476	134%
Healthnet Salud	$511	143%
Healthnet Comm-All Other Plans	$615	173%
Blue Shield Epn Ifp	$654	183%
Cigna	$663	186%
Blue Cross Blue Shield	$1,140	320%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $454.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 74177.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health White Memorial Montebello is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 74177.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.