CT abdomen and pelvis with contrast at Mercy Hospital Jefferson. CPT 74177.
What Mercy Hospital Jefferson publishes for this service, straight from its standard-charges file, last updated June 10, 2026.
Outpatient / ER
$3,931cash price (self-pay)
$6,047list price
$261–$6,047range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medicaid [20240] | Hb Jefn Mo Medicaid | $304 |
| Aetna Medicare Advantage Contracted [320010] | Hb Jefn Coventry Medica | $343 |
| Aetna Medicare Advantage Contracted [320010] | Hb Jefn Aetna/Coventry | $343 |
| BCBS Medicare Advantage Contracted [320047] | Hb Jefn Medicare And 100 | $343 |
| Cherokee Nation Health Serv Contracted [320066] | Hb Jefn Medicare And | $343 |
| Dept Of Veteran Affairs Contracted [320106] | Hb Jefn Medicare And 100 | $343 |
| Globalhealth Contracted [320145] | Hb Jefn Medicare And 100% Managed M | $343 |
| Cigna Medicare Advantage Contracted [320072] | Hb Jefn Cigna Managed M | $350 |
| Blue Cross And Blue Shield [20053] | Hb Jefn Anthem Pathway/Exchange E | $356 |
| Essence Healthcare Medicare Contracted [320122] | Hb Jefn Essence Medi | $360 |
| Aither Health [20449] | Hb Wash Jefn Shine Solar Dec New 110320 | $367 |
| Mercy Benefit Admin [20251] | Hb Wash Jefn Schaefer Autobody Dec New 0 | $367 |
| Mercy Benefit Admin [20251] | Hb Wash Jefn Dec Show Me Benefit Consort | $367 |
| Mercy Benefit Admin [20251] | Hb Wash Jefn Dec Eba - Employer Benefit | $367 |
| Mercy Benefit Admin [20251] | Hb Wash Jefn Dec Clayco | $367 |
| Healthlink Contracted [320179] | Hb Wash Jefn Sapaugh Motors Dec New 1 | $367 |
| Mercy Benefit Admin Contracted [320251] | Hb Wash Jefn Bartel Communic | $367 |
| Mercy Benefit Admin Contracted [320251] | Hb Wash Jefn Tall Tree Dec N | $367 |
| Mercy Benefit Admin Contracted [320251] | Hb Wash Jefn Dec Town And Co | $367 |
| Mercy Benefit Admin Contracted [320251] | Hb Wash Jefn Dec Quick Trip | $367 |
| Mercy Benefit Admin Contracted [320251] | Hb Wash Jefn Dec Clayco | $367 |
| Mercy Benefit Admin Contracted [320251] | Hb Wash Jefn Schaefer Autobo | $367 |
| Mercy Benefit Admin Contracted [320251] | Hb Wash Jefn Dec Show Me Ben | $367 |
| Mercy Benefit Admin Contracted [320251] | Hb Wash Jefn Dec Eba - Emplo | $367 |
| Medicaid Pending [20241] | Hb Jefn & Wash Home State Health Plan Manag | $381 |
| Home State Medicaid Contracted [320189] | Hb Jefn & Wash Home State He | $381 |
| Blue Cross And Blue Shield [20053] | Hb Jefn Anthem Blue Preferred Eff | $390 |
| Healthlink Contracted [320179] | Hb Jefn Healthlink HMO | $391 |
| Healthlink Contracted [320179] | Hb Jefn Dec Emcap Ebso | $391 |
| Mercy Benefit Admin [20251] | Hb Wash & Jefn Hermann Area District Hos | $420 |
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