CT abdomen and pelvis with contrast at Mercy Hospital Lebanon. CPT 74177.
What Mercy Hospital Lebanon publishes for this service, straight from its standard-charges file, last updated June 10, 2026.
Outpatient / ER
$1,991cash price (self-pay)
$3,063list price
$153–$2,910range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medicaid [20240] | Hb Lebn Ok Medicaid | $189 |
| Kancare Contracted [320213] | Hb Lebn Aetna Better Health (Kancare) | $207 |
| Kancare [20213] | Hb Lebn Aetna Better Health (Kancare) | $207 |
| Mo Medicaid Bh Carve Out [320315] | Hb Lebn Mo Medicaid | $304 |
| Medicaid [20240] | Hb Lebn Mo Medicaid | $304 |
| HUMANA MEDICARE ADVANTAGE CONTRACTED [320194] | HB LEBN HUMANA MCR New | $367 |
| Longevity Health Plan Medicare Contracted [320225] | Hb Lebn Medicare | $367 |
| Globalhealth Contracted [320145] | Hb Lebn Medicare | $367 |
| Champva [20065] | Hb Lebn Medicare | $367 |
| Cross Timbers Hospice [20098] | Hb Lebn Medicare | $367 |
| BCBS Medicare Advantage [20047] | Hb Lebn Medicare | $367 |
| BCBS Medicare Advantage Contracted [320047] | Hb Lebn Medicare | $367 |
| Aetna Medicare Advantage Contracted [320010] | Hb Lebn Medicare | $367 |
| Essence Healthcare Medicare Contracted [320122] | Hb Lebn Medicare | $367 |
| Cherokee Nation Health Serv Contracted [320066] | Hb Lebn Medicare | $367 |
| Cigna Medicare Advantage Contracted [320072] | Hb Lebn Medicare | $367 |
| Dept Of Veteran Affairs Contracted [320106] | Hb Lebn Medicare | $367 |
| Medicare [20244] | Hb Lebn Medicare | $367 |
| Mercy Hospice Okc [20252] | Hb Lebn Medicare | $367 |
| Elara Caring Aspire Hospice [20433] | Hb Lebn Medicare | $367 |
| Halo Hcr Inc Hospice [20432] | Hb Lebn Medicare | $367 |
| United Healthcare Medicaid Contracted [320397] | Hb Lebn UHC Mo Medica | $457 |
| BCBS Medicaid Contracted [320046] | Hb Lebn Mo Care Health Plan/Health | $460 |
| Healthscope Contracted [320182] | Hb Lebn Dec Orscheln Mcr 125% | $468 |
| Home State Medicaid Contracted [320189] | Hb Lebn Home State Health Pl | $502 |
| Ambetter Contracted [320452] | Hb Lebn Ambetter Exchange Mo | $691 |
| Sunflower Health Plan Contracted [320369] | Hb Lebn Ambetter Exchange | $691 |
| Novasys Contracted [320285] | Hb Lebn Ambetter Exchange Mo | $691 |
| Home State Health Plan Contracted [320187] | Hb Lebn Ambetter Exchange | $691 |
| Medica [20239] | Hb Sprg Lebn Medica Exchange | $836 |
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