CT abdomen and pelvis with contrast at Ascension St. John Jane Phillips (Jane Phillips Memorial Medical Center, Inc.). CPT 74177.
What Ascension St. John Jane Phillips (Jane Phillips Memorial Medical Center, Inc.) publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$1,188cash price (self-pay)
$3,210list price
$222–$873range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna Whole Health | 2659_mcok, Baok, Ohok Aetna Whole Health 20241001 | $222 |
| Aetna Whole Health | 2651_jpok Aetna Whole Health 20241001 | $334 |
| Champva | 2690_mcok, Baok, Ohok, Jpok Medicare Advantage Champva Outpa | $364 |
| Community Care - St John Network Senior - Govt | 2683_jpok, Baok, Mcok | $364 |
| Communitycare Senior | 2681_jpok, Baok, Mcok, Ohok Communitycare Outpa | $364 |
| Life Pace | 2702_medicare Advantage Life Pace Outpatient 20250101 | $364 |
| Longevity Health Plan Of Oklahoma | 2697_baok, Jpok, Mcok, Ohok Medica | $364 |
| Misc Medicare Advantage | 2701_mcok, Baok, Ohok, Jpok Medicare Advanta | $364 |
| Va Community Care Network | 1218_veteran Affairs Community Care Networ | $364 |
| Va Optum | 2679_va Optum Health Outpatient 20250101 | $364 |
| Veterans Administration | 2992_veterans Administration 20251001 | $364 |
| Humana Mcr | 2700_mcok, Baok, Ohok, Jpok Medicare Advantage Humana PPO | $367 |
| UHC Cherokee Nation | 2699_baok, Jpok, Mcok, Ohok United Health Cherok | $375 |
| United Health Care Medicare | 2698_baok, Jpok, Mcok, Ohok United Healt | $375 |
| Blue Cross Blue Shield Medicare | 2695_baok, Jpok, Mcok, Ohok Blue Cro | $382 |
| Community Care (Select) 7/1/13 | 2682_jpok, Baok, Mcok, Ohok Community | $437 |
| Smarthealth | 2703_baok, Jpok, Mcok, Ohok Smarthealth Outpatient 20250 | $509 |
| Blue Cross Blue Shield Blue Advantage | 2718_jpok Blue Cross Blue Shie | $706 |
| Blue Cross Blue Shield Choice | 2726_jpok Blue Cross Blue Shield Blue | $706 |
| Blue Cross Blue Shield Lincs | 2732_jpok Blue Cross Blue Shield Blue L | $706 |
| Blue Cross Blue Shield Preferred | 2737_jpok Blue Cross Blue Shield Bl | $706 |
| Blue Cross Blue Shield Traditional | 2742_jpok Blue Cross Blue Shield | $706 |
| Connect Health Benefit | 2696_baok, Jpok, Mcok, Ohok Connect Health Be | $728 |
| Evolutions | 2677_evolutions And Resource One Administrators Outpatien | $728 |
| Kempton Group Administrators | 2676_baok, Jpok, Mcok, Ohok Kempton Gro | $819 |
| Communitycare (Select) | 2684_jpok, Baok, Mcok, Ohok Communitycare Sta | $837 |
| Community Care Smarthealth | 2680_jpok, Baok, Mcok, Ohok Communitycare | $873 |
Inpatient
—cash price (self-pay)
—list price
$364–$873range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Champva | 2969_mcok, Baok, Ohok, Jpok Medicare Advantage Champva Inpat | $364 |
| Community Care - St John Network Senior - Govt | 2970_jpok, Baok, Mcok | $364 |
| Communitycare Senior | 2978_jpok, Baok, Mcok, Ohok Communitycare Inpat | $364 |
| Life Pace | 2984_medicare Advantage Life Pace Inpatient 20251001 | $364 |
| Longevity Health Plan Of Oklahoma | 2985_baok, Jpok, Mcok, Ohok Medica | $364 |
| Misc Medicare Advantage | 2987_mcok, Baok, Ohok, Jpok Medicare Advanta | $364 |
| Va Community Care Network | 2964_veteran Affairs Community Care Networ | $364 |
| Va Optum | 2963_va Optum Health Inpatient 20251001 | $364 |
| Humana Mcr | 2982_mcok, Baok, Ohok, Jpok Medicare Advantage Humana PPO | $367 |
| UHC Cherokee Nation | 2990_baok, Jpok, Mcok, Ohok United Health Cherok | $375 |
| United Health Care Medicare | 2991_baok, Jpok, Mcok, Ohok United Healt | $375 |
| Blue Cross Blue Shield Medicare | 2965_baok, Jpok, Mcok, Ohok Blue Cro | $382 |
| Communitycare (Standard) | 711_communitycare Standard Inpatient 201801 | $400 |
| Community Care (Select) 7/1/13 | 2971_jpok, Baok, Mcok, Ohok Community | $437 |
| Ccl&H | 2968_baok, Jpok, Ohok, Mcok Community Care Life And Health Inp | $473 |
| Smarthealth | 2988_baok, Jpok, Mcok, Ohok Smarthealth Inpatient 202510 | $509 |
| Community Care Smarthealth | 2973_jpok, Baok, Mcok, Ohok Communitycare | $546 |
| Communitycare (Select) | 2975_jpok, Baok, Mcok, Ohok Communitycare Sta | $546 |
| Connect Health Benefit | 2980_baok, Jpok, Mcok, Ohok Connect Health Be | $728 |
| Evolutions | 2981_evolutions And Resource One Administrators Inpatient | $728 |
| Kempton Group Administrators | 2983_baok, Jpok, Mcok, Ohok Kempton Gro | $819 |
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