CT abdomen and pelvis with contrast at St. Luke's Health - Brazosport Hospital. CPT 74177.
What St. Luke's Health - Brazosport Hospital publishes for this service, straight from its standard-charges file, last updated February 28, 2026.
Outpatient / ER
$7,068cash price (self-pay)
$20,195list price
$265–$10,098range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| CHC | Medicaid|CHIP | $265 |
| UNITED | Medicaid|All Other Plans | $318 |
| BCBS | Medicaid|All Plans | $328 |
| CHC | Medicaid|All Other Plans | $328 |
| SUPERIOR | Medicaid|All Plans | $328 |
| BCBS | Medicare|All Plans | $358 |
| CIGNA-HEALTHSPRING | Medicare|All Plans | $358 |
| HUMANA | Medicare|All Plans | $358 |
| KELSEY | Medicare|All Plans | $358 |
| UNITED | Medicare|All Plans | $358 |
| United | Commercial|All Other Plans | $365 |
| SELECTCARE | Medicare|All Plans | $368 |
| WellcareTP | Medicare|All Plans | $368 |
| Community Health Choice | Commercial|Exchange | $376 |
| Devoted | Medicare|All Plans | $383 |
| SCANHealth | Medicare|All Plans | $383 |
| UNITED | Medicaid|STAR | $426 |
| CHC | Medicaid|STAR | $440 |
| Aetna | Commercial|All Other Plans | $508 |
| Ambetter | Commercial|All Plans | $519 |
| Wellpoint | Commercial|Exchange | $537 |
| Aetna | Commercial|Exchange | $551 |
| United | Commercial|Exchange | $554 |
| Bright Health | Commercial|All Plans | $616 |
| BCBS-TX | Commercial|Blue Advantage HMO | $661 |
| BCBS-TX | Commercial|Blue Options | $738 |
| BCBS-TX | Commercial|Traditional | $819 |
| Humana | Commercial|All Plans | $933 |
| Entrust | Commercial|All Plans | $970 |
| UNITED | Medicaid|STARPLUS | $973 |
Inpatient
$7,068cash price (self-pay)
$20,195list price
$10,098–$10,098range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Health First | Commercial|All Plans | $10,098 |
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All common services at St. Luke's Health - Brazosport Hospital