CT abdomen and pelvis with contrast at Mercy Hospital Southeast. CPT 74177.
What Mercy Hospital Southeast publishes for this service, straight from its standard-charges file, last updated June 11, 2026.
Outpatient / ER
$1,081cash price (self-pay)
$1,663list price
$108–$2,242range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Imagine 360 Contracted [320494] | Hb Cape Dec Robinson Construction Ne | $231 |
| Medicaid [20240] | Hb Cape Mo Medicaid | $304 |
| Medica Medicare Advantage Contracted [320477] | Hb Cape Medicare And 1 | $343 |
| Prominence Health Plan Medicare Advantage Contracted [320496] | Hb Cap | $343 |
| BCBS Medicare Advantage [20047] | Hb Cape Medicare And 100% Managed Me | $343 |
| Cross Timbers Hospice [20098] | Hb Cape Medicare And 100% Managed Medi | $343 |
| Medicare [20244] | Hb Cape Medicare And 100% Managed Medicare | $343 |
| Mercy Hospice Okc [20252] | Hb Cape Medicare And 100% Managed Medicare | $343 |
| Humana Medicare Advantage Contracted [320194] | Hb Cape Humana Medicar | $343 |
| Kindful Hospice [20434] | Hb Cape Medicare And 100% Managed Medicare | $343 |
| Elara Caring Aspire Hospice [20433] | Hb Cape Medicare And 100% Manage | $343 |
| Halo Hcr Inc Hospice [20432] | Hb Cape Medicare And 100% Managed Medic | $343 |
| Aetna Medicare Advantage Contracted [320010] | Hb Cape Aetna Medicare | $343 |
| Provider Partners Health Plans Contracted [320450] | Hb Cape Provider | $394 |
| Home State Medicaid Contracted [320189] | Hb Cape Home State Managed M | $405 |
| Medicaid Pending [20241] | Hb Cape Home State Managed Medicaid | $405 |
| Ambetter Contracted [320452] | Hb Cape Home State Ambetter Exchange Bh | $444 |
| Home State Health Plan Contracted [320187] | Hb Cape Home State Ambett | $444 |
| United Healthcare Medicaid Contracted [320397] | Hb Cape UHC Managed M | $457 |
| Healthlink Contracted [320179] | Hb Cape Healthlink State Of Illinois | $543 |
| BCBS Medicaid Contracted [320046] | Hb Cape Missouri Care Health Plan/ | $548 |
| Medicaid Pending [20241] | Hb Cape Missouri Care Health Plan/Healthy B | $548 |
| Auxiant Contracted [320462] | Hb Cape City Of Jackson Dec 165% W/O Seq | $577 |
| Ebms Contracted [320493] | Hb Cape Crader Distributing Dec 165% W/O Se | $577 |
| Healthlink Contracted [320179] | Hb Cape Schaefer Electrical Dec 165% | $577 |
| Reflect Health Contracted [320492] | Hb Cape Ww Woods Dec 171% Default | $598 |
| Consociate Consolidated Health Contracted [320490] | Hb Cape Dec Conso | $600 |
| Auxiant Contracted [320462] | Hb Cape Dec Buchheit Ip 225% Op 200% Def | $686 |
| Healthlink Contracted [320179] | Hb Cape Dec Consociate Ip 225% Op 225 | $771 |
| Hope Trust Contracted [320488] | Hb Cape Dec Hope Trust Ip 250% Op 250 | $857 |
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