CT abdomen and pelvis with contrast at St. Luke's Health - Springwoods Village Hospital. CPT 74177.
What St. Luke's Health - Springwoods Village Hospital publishes for this service, straight from its standard-charges file, last updated February 28, 2026.
Outpatient / ER
$6,736cash price (self-pay)
$19,247list price
$258–$19,247range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Renaissance | Commercial|All Plans | $258 |
| Montgomery Hospital District | Commercial|All Plans | $312 |
| BCBS | Medicaid|All Plans | $328 |
| CHC | Medicaid|All Other Plans | $366 |
| KelseyCare | Commercial|Exchange | $483 |
| Cigna | Commercial|Surefit | $507 |
| Cigna | Commercial|All Other Plans | $537 |
| Community Health Choice | Commercial|Exchange | $537 |
| Superior Health Plan | Commercial|All Plans | $537 |
| BCBS-TX | Commercial|MyBlue Health Exchange | $558 |
| Cigna | Commercial|HMO | $559 |
| Aetna | Commercial|Transplant | $590 |
| Bright Health | Commercial|All Plans | $616 |
| BCBS-TX | Commercial|Exchange | $649 |
| Aetna | Commercial|PPO | $667 |
| Humana | Commercial|HMO | $800 |
| Humana | Commercial|PPO | $800 |
| Healthsmart | Commercial|AP3-PPO | $900 |
| KelseyCare | Commercial|All Other Plans | $1,155 |
| NXHealth | Commercial|All Plans | $1,163 |
| BCBS-TX | Commercial|Blue Premier | $1,184 |
| United | Commercial|Exchange | $1,315 |
| Cigna | Commercial|PPO | $1,405 |
| BCBS-TX | Commercial|HMO | $1,478 |
| BCBS-TX | Commercial|PPO | $1,661 |
| United | Commercial|HMO | $2,156 |
| United | Commercial|PPO | $2,156 |
| United | Commercial|Optum | $9,046 |
| CHC | Medicaid|CHIP | $10,586 |
| Aetna-Kelsey Care | Commercial|HMO | $11,356 |
Inpatient
$6,736cash price (self-pay)
$19,247list price
$8,276–$19,247range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| TCHPCHIP | Medicaid|HMO | $8,276 |
| CHC | Medicaid|CHIP | $10,586 |
| CHC | Medicaid|HMO | $10,586 |
| TEXASTRUECHOICE | Medicaid|CHIP | $10,586 |
| Coventry | Commercial|PPO | $12,511 |
| First Health | Commercial|All Plans | $12,511 |
| Cigna | Commercial|Transplant | $13,473 |
| Healthsmart | Commercial|PPO | $13,473 |
| Interlink | Commercial|Transplant | $13,473 |
| MultiPlan | Commercial|All Plans | $14,435 |
| USA Health Network | Commercial|All Plans | $16,360 |
| MHealth Network | Commercial|PPO | $19,247 |
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All common services at St. Luke's Health - Springwoods Village Hospital