CT abdomen and pelvis with contrast at Lake Granbury Medical Center. CPT 74177.
What Lake Granbury Medical Center publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$434cash price (self-pay)
$11,857list price
$145–$20,240range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| BCBS TX | BCBS TX Blue ADV | $330 |
| NODE Tricare | NODE Tricare | $333 |
| NODE ChampVA | NODE ChampVA | $350 |
| NODE Aetna CHIP Medicaid TX | NODE Aetna CHIP Medicaid TX | $462 |
| NODE Cook Childrens Health Plan CHIP Medicaid TX | NODE Cook Childrens | $462 |
| Medicaid | NODE TX Medicaid | $462 |
| NON PAR TX Medicaid | NODE TX Medicaid NON PAR | $462 |
| NODE UHC CHIP/STAR KIDS Medicaid TX | NODE UHC CHIP Medicaid TX | $462 |
| NODE UHC STAR KIDS Medicaid TX | NODE UHC STAR KIDS Medicaid TX | $462 |
| NODE UHC STAR Medicaid TX | NODE UHC STAR Medicaid TX | $462 |
| Healthspring | NODE Cigna Healthspring Medicaid TX | $485 |
| NODE Molina CHIP Medicaid TX | NODE Molina CHIP Medicaid TX | $485 |
| NODE Molina Medicaid TX | NODE Molina STAR Medicaid TX | $485 |
| NODE Superior CHIP/STAR KIDS/ STAR HEALTH Medicaid TX | NODE Superior | $531 |
| NODE Superior STAR KIDS Medicaid TX | NODE Superior STAR KIDS Medicaid | $531 |
| Superior | NODE Superior STAR Medicaid TX | $531 |
| NODE Superior STAR PLUS Medicaid TX | NODE Superior STAR PLUS Medicaid | $531 |
| NODE Aetna STAR KIDS Medicaid TX | NODE Aetna STAR KIDS Medicaid TX | $628 |
| NODE Cook Childrens Health Plan STAR KIDS Medicaid TX | NODE Cook Chil | $628 |
| United Healthcare | NODE UHC STAR PLUS Medicaid TX | $1,431 |
| NODE Molina STAR PLUS Medicaid TX | NODE Molina STAR PLUS Medicaid TX | $1,503 |
| Aetna | NODE Aetna STAR Medicaid TX | $1,662 |
| NODE Cook Childrens Health Plan Medicaid TX | NODE Cook Childrens Heal | $1,662 |
| Amerigroup | NODE Wellpoint CHIP Medicaid TX | $1,693 |
| BCBS TX | BCBS TX HMO | $1,709 |
| BCBS TX | BCBS TX PPO Trad | $1,709 |
| CHS Group Health Plan BCBST | CHS Group Health Plan BCBST | $2,988 |
| Cigna | Cigna New Business | $3,012 |
| Cigna | Cigna ALL | $4,672 |
| Aetna | Aetna Whole Health | $5,395 |
Inpatient
$650cash price (self-pay)
$11,857list price
$265–$20,240range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Self Pay | Self Pay | $1,304 |
| CHS Group Health Plan BCBST | CHS Group Health Plan BCBST | $2,988 |
| Cigna | Cigna New Business | $3,012 |
| United Healthcare | UHC APA | $5,040 |
| Aetna | Aetna Whole Health | $5,395 |
| Aetna | Aetna NBD | $5,691 |
| Aetna | Aetna PPO HMO | $6,344 |
| Healthsmart | Healthsmart ACCEL | $6,521 |
| Aetna | Aetna NAB First Health Rental | $6,747 |
| Aetna | Aetna Auto | $8,146 |
| Healthsmart | Healthsmart PPO HPO | $8,300 |
| Santa Fe Hospital Association | Santa Fe Hospital Association | $9,486 |
| Multiplan | Multiplan Complementary | $10,434 |
| Galaxy Health | Galaxy Health PPO | $11,264 |
| MedCorp Southwest | MedCorp Southwest | $11,264 |
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