CT abdomen and pelvis with contrast at Ascension Seton Edgar B. Davis (Ascension Seton). CPT 74177.
What Ascension Seton Edgar B. Davis (Ascension Seton) publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$2,754cash price (self-pay)
$9,799list price
$223–$5,376range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| BCBS Star | 4221_chirp Blue Cross Star (Ebd) Outpatient 20241201 | $223 |
| Dell Star | 4232_chirp Dell Star (Ebd) Outpatient 20241201 | $223 |
| Champva | 1136_champva Austin 20180301 | $229 |
| BCBS Chip/Chip Perinate | 3594_blue Cross Chip/Star Kids (Chi,Dcn) Inp | $253 |
| Dell Chip/Chip Perinate | 3605_dell Chip/Star Kids (Chi,Dcn) Inpatient | $253 |
| Dell Star | 3704_chirp Dell Star (Chi,Dcn) Inpatient 20240901 | $253 |
| BCBS Star | 3693_chirp Blue Cross Star (Chi,Dcn) Inpatient 20240901 | $294 |
| BCBS Star | 4219_chirp Blue Cross Star (Chi,Dcn) Outpatient 20241201 | $294 |
| Dell Chip/Chip Perinate | 4179_dell Chip/Star Kids (Chi,Dcn) Outpatien | $294 |
| Dell Star | 4230_chirp Dell Star (Chi,Dcn) Outpatient 20241201 | $294 |
| Superior Ambetter | 3879_superior Ambetter (Chi,Dcn) Inpatient 2024090 | $294 |
| Champva | 1135_champva Rest_tx 20180301 | $301 |
| BCBS Chip/Chip Perinate | 4168_blue Cross Chip (Chi,Dcn) Outpatient 20 | $318 |
| BCBS Chip/Chip Perinate | 4168_blue Cross Chip/Star Kids (Chi,Dcn) Out | $318 |
| BCBS Star Kids | 5003_blue Cross Star Kids (Chi,Dcn) Outpatient 202412 | $318 |
| Superior Ambetter | 3880_superior Ambetter (Chi,Dcn) Outpatient 202409 | $318 |
| BCBS Bav Exchange | 4127_blue Cross Blue Shield Bav Exchange 20250101 | $405 |
| BCBS Chip/Chip Perinate | 3596_blue Cross Chip/Star Kids (Ebd) Inpatie | $464 |
| BCBS Star | 3695_chirp Blue Cross Star (Ebd) Inpatient 20240901 | $464 |
| Dell Chip/Chip Perinate | 3607_dell Chip/Star Kids (Ebd) Inpatient 202 | $464 |
| Dell Star | 3706_chirp Dell Star (Ebd) Inpatient 20240901 | $464 |
| BCBS Chip/Chip Perinate | 4170_blue Cross Chip (Ebd) Outpatient 202412 | $464 |
| BCBS Chip/Chip Perinate | 4170_blue Cross Chip/Star Kids (Ebd) Outpati | $464 |
| BCBS Star Kids | 5007_blue Cross Star Kids (Ebd) Outpatient 20241201 | $464 |
| Dell Chip/Chip Perinate | 4181_dell Chip/Star Kids (Ebd) Outpatient 20 | $464 |
| Aetna Sha Aisd | 4335_aetna Sha Aisd 20250101 | $1,345 |
| BCBS Hpn | 4440_blue Cross Blue Shield Hpn 20250501 | $1,401 |
| BCBS Hpn | 4497_blue Cross Blue Shield Hpn (Dell, Williamson,Hays) 202 | $1,401 |
| Aetna Aco HMO | 4489_aetna Aco HMO 20250801 | $1,523 |
| Aetna Multi-Tier Whole Health Sha | 4490_aetna Multi-Tier Whole Health | $1,523 |
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All common services at Ascension Seton Edgar B. Davis (Ascension Seton)