CT abdomen and pelvis with contrast at Mercy Hospital Perry. CPT 74177.
What Mercy Hospital Perry publishes for this service, straight from its standard-charges file, last updated March 12, 2026.
Outpatient / ER
$455cash price (self-pay)
$2,643list price
$105–$4,585range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medicaid [20240] | Hb Wash Jefn Linc Samc Pcmh Stod IL Medicaid | $396 |
| Humana Medicare Advantage [20194] | Hb Pcmh Medicare/Managed Mcr W/Seq | $804 |
| Cross Timbers Hospice [20098] | Hb Pcmh Medicare/Managed Mcr W/Seq 98. | $804 |
| BCBS Medicare Advantage [20047] | Hb Pcmh Medicare/Managed Mcr W/Seq 9 | $804 |
| Blue Cross And Blue Shield [20053] | Hb Pcmh Medicare/Managed Mcr W/Se | $804 |
| Kindful Hospice [20434] | Hb Pcmh Medicare/Managed Mcr W/Seq 98.1% | $804 |
| Elara Caring Aspire Hospice [20433] | Hb Pcmh Medicare/Managed Mcr W/S | $804 |
| Medicare [20244] | Hb Pcmh Medicare/Managed Mcr W/Seq 98.1% | $804 |
| Halo Hcr Inc Hospice [20432] | Hb Pcmh Medicare/Managed Mcr W/Seq 98.1 | $804 |
| Mercy Hospice Okc [20252] | Hb Pcmh Medicare/Managed Mcr W/Seq 98.1% | $804 |
| BCBS Medicare Advantage Contracted [320047] | Hb Pcmh Medicare/Managed | $804 |
| Cherokee Nation Health Serv Contracted [320066] | Hb Pcmh Medicare/Man | $804 |
| Dept Of Veteran Affairs Contracted [320106] | Hb Pcmh Medicare/Managed | $804 |
| Globalhealth Contracted [320145] | Hb Pcmh Medicare/Managed Mcr W/Seq | $804 |
| Essence Healthcare Medicare Contracted [320122] | Hb Pcmh Essence 100% | $819 |
| Aetna Medicare Advantage Contracted [320010] | Hb Pcmh Aetna/Coventry | $836 |
| Dept Of Veteran Affairs Contracted [320106] | Hb Pcmh UHC Va 100% Mcr | $951 |
| Ambetter [20452] | Hb Pcmh Ambetter Exchange | $1,253 |
| Blue Cross And Blue Shield [20053] | Hb Stlo Wash Jefn Linc Samc Cape | $1,255 |
| Blue Cross And Blue Shield [20053] | Hb Pcmh Anthem Blue Preferred | $1,638 |
| Blue Cross And Blue Shield [20053] | Hb Pcmh Anthem Pathway/Exchange | $1,638 |
| First Health [20128] | Hb Pcmh Linc Aetna Coventry All Products | $1,731 |
| Aetna [20008] | Hb Pcmh Linc Aetna Coventry All Products | $1,731 |
| Aetna Contracted [320008] | Hb Pcmh Linc Aetna Coventry All Products | $1,731 |
| First Health Contracted [320128] | Hb Pcmh Linc Aetna Coventry All Pro | $1,731 |
| Blue Cross And Blue Shield [20053] | Hb Pcmh Anthem Blue Access | $1,850 |
| Mc Generic Anthem [20456] | Hb Pcmh Anthem Blue Access | $1,850 |
| Mc Anthem [20455] | Hb Pcmh Anthem Blue Access | $1,850 |
| Cigna Healthcare Contracted [320071] | Hb Pcmh Cigna | $1,969 |
| Blue Cross And Blue Shield [20053] | Hb Pcmh Anthem Traditional | $2,035 |
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