CT abdomen and pelvis with contrast at Grace Surgical Hospital. CPT 74177.
What Grace Surgical Hospital publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$460cash price (self-pay)
$3,136list price
$340–$1,875range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Bcbs | Vapc3 Government | $340 |
| Aetna | Medicare Managed Care Plan | $350 |
| Superior | Wellcare Medicare Managed Care Plan | $368 |
| Unitedhealthcare | Medicare Managed Care Plan | $370 |
| Baylor Scott And White | Individual Bsw Premier Exchange | $601 |
| Baylor Scott And White | Group Bsw Premier/Covenant Preferred All Comm | $727 |
| Bcbs | Par Traditional | $932 |
| Baylor Scott And White | Group Bsw Plus All Commercial Plans | $1,013 |
| Aetna | Preferred Other Commercial Plan | $1,348 |
| Bcbs | Ppo | $1,806 |
| Bcbs | Ers Hmo | $1,875 |
| Bcbs | Hmo | $1,875 |
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