CT abdomen and pelvis with contrast at Ascension Seton Smithville (Ascension Seton). CPT 74177.
What Ascension Seton Smithville (Ascension Seton) publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$2,626cash price (self-pay)
$8,434list price
$229–$4,309range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Champva | 1136_champva Austin 20180301 | $229 |
| BCBS Chip/Chip Perinate | 3594_blue Cross Chip/Star Kids (Chi,Dcn) Inp | $253 |
| BCBS Chip/Chip Perinate | 3600_blue Cross Chip/Star Kids (Smv) Inpatie | $253 |
| BCBS Star | 3699_chirp Blue Cross Star (Smv) Inpatient 20240901 | $253 |
| Dell Chip/Chip Perinate | 3605_dell Chip/Star Kids (Chi,Dcn) Inpatient | $253 |
| Dell Chip/Chip Perinate | 3611_dell Chip/Star Kids (Smv) Inpatient 202 | $253 |
| Dell Star | 3704_chirp Dell Star (Chi,Dcn) Inpatient 20240901 | $253 |
| Dell Star | 3710_chirp Dell Star (Smv) Inpatient 20240901 | $253 |
| BCBS Chip/Chip Perinate | 4174_blue Cross Chip/Star Kids (Smv) Outpati | $294 |
| BCBS Star | 3693_chirp Blue Cross Star (Chi,Dcn) Inpatient 20240901 | $294 |
| BCBS Star | 4219_chirp Blue Cross Star (Chi,Dcn) Outpatient 20241201 | $294 |
| BCBS Star | 4225_chirp Blue Cross Star (Smv) 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 Chip/Chip Perinate | 4174_blue Cross Chip (Smv) Outpatient 202412 | $318 |
| BCBS Star Kids | 5003_blue Cross Star Kids (Chi,Dcn) Outpatient 202412 | $318 |
| BCBS Star Kids | 5015_blue Cross Star Kids (Smv) Outpatient 20241201 | $318 |
| Dell Chip/Chip Perinate | 4185_dell Chip/Star Kids (Smv) Outpatient 20 | $318 |
| Dell Star | 4236_chirp Dell Star (Smv) Outpatient 20241201 | $318 |
| Superior Ambetter | 3880_superior Ambetter (Chi,Dcn) Outpatient 202409 | $318 |
| BCBS Bav Exchange | 4127_blue Cross Blue Shield Bav Exchange 20250101 | $405 |
| 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 Smithville (Ascension Seton)