CT abdomen and pelvis with contrast at Medical Center Of Southeast Texas. CPT 74177.
What Medical Center Of Southeast Texas publishes for this service, straight from its standard-charges file, last updated September 2, 2026.
Outpatient / ER
$345cash price (self-pay)
$12,651list price
$312–$12,651range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Texas Childrens Health Plan | Texas Childrens Health Plan | $312 |
| Superior Health Plan Medicaid | Superior Health Plan Medicaid | $325 |
| Community Health Choice CHIP | Community Health Choice CHIP | $328 |
| Molina Medicaid | Molina Medicaid | $328 |
| Texas Childrens Health Plan STAR KIDS | Texas Childrens Health Plan ST | $328 |
| United Healthcare Medicaid Star/Chips | United Healthcare Medicaid Sta | $328 |
| BCBS of Texas Medicare Adv HMO | BCBS of Texas Medicare Adv HMO | $345 |
| Healthspring Medicare Advantage | Healthspring Medicare Advantage | $345 |
| Tricare | Tricare | $350 |
| Community Health Choice HIX | Community Health Choice HIX | $421 |
| BCBS of Texas Blue Advantage HMO HIX | BCBS of Texas Blue Advantage HM | $439 |
| BCBS of Texas Premier | BCBS of Texas Premier | $443 |
| Wellpoint Amerigroup Star Kids/CHIPS | Wellpoint Amerigroup Star Kids/ | $515 |
| Wellpoint Amerigroup STAR UHRIP | Wellpoint Amerigroup STAR UHRIP | $579 |
| Community Health Choice STAR UHRIP | Community Health Choice STAR UHRI | $608 |
| Molina Healthcare STAR UHRIP | Molina Healthcare STAR UHRIP | $608 |
| United Healthcare STAR UHRIP | United Healthcare STAR UHRIP | $608 |
| Cigna Commercial | Cigna Commercial | $630 |
| ELAP Services | ELAP Services | $679 |
| Wellpoint Amerigroup STAR PLUS UHRIP | Wellpoint Amerigroup STAR PLUS | $821 |
| United Healthcare Commercial | United Healthcare Commercial | $860 |
| Molina Healthcare STAR PLUS UHRIP | Molina Healthcare STAR PLUS UHRIP | $862 |
| United Healthcare STAR PLUS UHRIP | United Healthcare STAR PLUS UHRIP | $862 |
| Aetna HMO | Aetna HMO | $875 |
| Humana Commercial | Humana Commercial | $1,427 |
| Texas Childrens Health Plan Star UHRIP | Texas Childrens Health Plan S | $1,824 |
| BCBS of Texas HMO | BCBS of Texas HMO | $2,085 |
| Texas Childrens Health Plan STAR PLUS UHRIP | Texas Childrens Health P | $2,585 |
| BCBS of Texas Traditional | BCBS of Texas Traditional | $5,225 |
| Magellan Behavioral Health | Magellan Behavioral Health | $7,591 |
Inpatient
—cash price (self-pay)
$12,651list price
$5,225–$12,651range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| BCBS of Texas Traditional | BCBS of Texas Traditional | $5,225 |
| Magellan Behavioral Health | Magellan Behavioral Health | $7,591 |
| Galaxy Health Network | Galaxy Health Network | $8,856 |
| Texas Municipal League | Texas Municipal League | $8,856 |
| Multiplan | Multiplan | $10,121 |
| United Behavioral Health | United Behavioral Health | $12,651 |
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