CT abdomen and pelvis with contrast at Baylor Scott & White Heart And Vascular Hospital - Dallas. CPT 74177.
What Baylor Scott & White Heart And Vascular Hospital - Dallas publishes for this service, straight from its standard-charges file, last updated June 29, 2026.
Outpatient / ER
$3,891cash price (self-pay)
$6,484list price
$312–$4,863range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Superior Health Plan | Medicaid | $312 |
| Baylor Scott & White Health Plan | Medicare Advantage | $333 |
| CORVEL | Worker's Compensation | $340 |
| Aetna | Medicare Advantage | $350 |
| TriWest | Community Care Network | $350 |
| American Health Plan | Medicare Advantage | $368 |
| Blue Cross Blue Shield | Medicare Advantage | $368 |
| HealthSpring | Medicare Advantage | $368 |
| ProCare Advantage | Medicare Advantage | $368 |
| Superior Health Plan | Medicare | $368 |
| United Healthcare | Medicare Advantage | $393 |
| Baylor Scott & White Health Plan | BSW Premier - Small Group | $421 |
| Baylor Scott & White Health Plan | BSW Premier - Individual | $440 |
| Prime Health Services | Worker's Compensation | $442 |
| Sedgwick | Preferred Network | $524 |
| Baylor Scott & White Health Plan | BSW Plus - Small Group | $578 |
| Superior Ambetter | Ambetter Exchange | $753 |
| Mark Cuban | Commercial | $953 |
| Blue Cross Blue Shield | Blue Advantage | $1,249 |
| Baylor Scott & White Health Plan | BSW Premier - Large Group/BSW Premi | $1,557 |
| Cigna | Local Plus | $1,673 |
| Blue Cross Blue Shield | Blue Premier/High Performance Network/My Blue | $1,772 |
| Baylor Scott & White Health Plan | BSW Plus - Large Group/BSW Premier | $1,832 |
| United Healthcare | Charter | $1,959 |
| United Healthcare | Nexus | $1,959 |
| Cigna | HMO/PPO | $1,968 |
| United Healthcare | Commercial Broad | $2,177 |
| Blue Cross Blue Shield | City of Dallas | $2,379 |
| Blue Cross Blue Shield | Blue Essentials (HMO) | $2,509 |
| Blue Cross Blue Shield | BlueChoice (PPO) | $2,642 |
Inpatient
$3,891cash price (self-pay)
$6,484list price
$3,566–$4,539range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| QuikTrip | Employee Benefit Plan | $3,566 |
| Curative | Commercial | $4,215 |
| First Health | PPO | $4,539 |
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All common services at Baylor Scott & White Heart And Vascular Hospital - Dallas