CT abdomen and pelvis with contrast at Mercy Orthopedic Hospital Fort Smith. CPT 74177.
What Mercy Orthopedic Hospital Fort Smith publishes for this service, straight from its standard-charges file, last updated June 8, 2026.
Outpatient / ER
$3,197cash price (self-pay)
$4,919list price
$189–$4,181range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Humana Medicare Advantage Contracted [320194] | Hb Ftsm Humana Mcr | $331 |
| Longevity Health Plan Medicare Contracted [320225] | Hb Ftsm Managed M | $331 |
| Globalhealth Contracted [320145] | Hb Ftsm Managed Medicare | $331 |
| Cherokee Nation Health Serv Contracted [320066] | Hb Ftsm Medicare | $331 |
| Dept Of Veteran Affairs Contracted [320106] | Hb Ftsm Medicare | $331 |
| Essence Healthcare Medicare Contracted [320122] | Hb Ftsm Managed Medi | $331 |
| Independent Health [20197] | Hb Ftsm Managed Medicare | $331 |
| Generic Medicare Managed Care [20137] | Hb Ftsm Managed Medicare | $331 |
| Horizons Medicare [20190] | Hb Ftsm Managed Medicare | $331 |
| Health First Health Plans Medicare [20170] | Hb Ftsm Managed Medicare | $331 |
| Cross Timbers Hospice [20098] | Hb Ftsm Managed Medicare | $331 |
| BCBS Medicare Advantage [20047] | Hb Ftsm Managed Medicare | $331 |
| Medicare [20244] | Hb Ftsm Medicare | $331 |
| Mental Health Network Medicare [20250] | Hb Ftsm Managed Medicare | $331 |
| Mercy Hospice Okc [20252] | Hb Ftsm Managed Medicare | $331 |
| American Health Advantage Of Mo Mcr [20264] | Hb Ftsm Managed Medicare | $331 |
| Tribute Health Plan Mcr [20338] | Hb Ftsm Managed Medicare | $331 |
| Tricare [20380] | Hb Ftsm Tricare | $331 |
| Unicare Medicare [20384] | Hb Ftsm Managed Medicare | $331 |
| University Pittsburgh Med Ctr Medicare [20407] | Hb Ftsm Managed Medic | $331 |
| Jordan Valley Senior Care Pace [20515] | Hb Ftsm Managed Medicare | $331 |
| Pace Of The Ozarks [20518] | Hb Ftsm Managed Medicare | $331 |
| Spina Bifida Hlthcare Benefit [20506] | Hb Ftsm Managed Medicare | $331 |
| Aetna Medicare Advantage Contracted [320010] | Hb Ftsm Managed Medicar | $331 |
| BCBS Medicare Advantage Contracted [320047] | Hb Ftsm Managed Medicare | $331 |
| Windsor Medicare [20424] | Hb Ftsm Managed Medicare | $331 |
| Medical Associates Health [20444] | Hb Ftsm Managed Medicare | $331 |
| Halo Hcr Inc Hospice [20432] | Hb Ftsm Managed Medicare | $331 |
| Elara Caring Aspire Hospice [20433] | Hb Ftsm Managed Medicare | $331 |
| Kindful Hospice [20434] | Hb Ftsm Managed Medicare | $331 |
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