CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Texas Scottish Rite Hospital for Children

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74177
Insurance Median: $589
Cash Discount Price: $1,001
vs. Medicare Baseline: 1.65x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Texas Scottish Rite Hospital for Children is $589. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,001. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 1.65x the Medicare baseline. Located in 2222 Welborn Street, Dallas, TX.

Cash / Self-Pay

$1,001

Average discount available for prompt cash payment at this facility.

Insurance Median

$589

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$356.43

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $356.43 (100%)

Cash / Self-Pay: $1,001 (281%)

Insurance Median: $589 (165%)

Cash: $1,001 (281% of Medicare)

Ins. Median: $589 (165% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $356.43 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$68 - $1,128	19%
Tricare	$88 - $321	25%
Blue Cross Blue Shield	$105 - $1,201	29%
Cigna	$155 - $655	43%
Children Med Center Health Plan - All Plans	$384 - $1,128	108%
Community First Health Plan-All Plans	$384 - $1,128	108%
Cook Childrens Hp-All Plans	$384 - $1,128	108%
Driscoll Childrens-All Plans	$384 - $1,128	108%
Medicaid / KanCare	$384 - $1,128	108%
Molina Commercial - All Other Plans	$384 - $1,128	108%
Soonercare-All Plans	$384 - $1,128	108%
UnitedHealthcare	$384 - $1,128	108%
Firstcare Health Mcaid	$403 - $1,184	113%
Tx Childrens Hlth Mcaid-All Plans	$403 - $1,184	113%
Firstcare Health Comm - All Other Plans	$611 - $790	171%
Healthscope - All Plans	$655 - $846	184%
Scott & White Comm- All Other Plans	$655 - $846	184%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $1,001.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 74177.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Texas Scottish Rite Hospital for Children is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 74177.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.