CT abdomen and pelvis with contrast at Mercy Hospital Ada. CPT 74177.
What Mercy Hospital Ada publishes for this service, straight from its standard-charges file, last updated June 11, 2026.
Outpatient / ER
$3,546cash price (self-pay)
$5,455list price
$189–$5,455range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Oklahoma Complete Health Medicaid Contracted [320485] | Hb Ada Ok Medi | $189 |
| Humana Medicaid Contracted [320486] | Hb Ada Ok Medicaid (Soonercare) | $189 |
| Aetna Medicaid Contracted [320009] | Hb Ada Ok Medicaid (Soonercare) | $189 |
| Medicaid [20240] | Hb Ada Ok Medicaid (Soonercare) | $189 |
| BCBS Medicare Advantage [20047] | Hb Ada Medicare/Mgd Medicare 100% | $345 |
| Mercy Hospice Okc [20252] | Hb Ada Medicare/Mgd Medicare 100% | $345 |
| Windsor Medicare [20424] | Hb Ada Medicare/Mgd Medicare 100% | $345 |
| Mental Health Network Medicare [20250] | Hb Ada Medicare/Mgd Medicare | $345 |
| Tricare [20380] | Hb Ada Tricare | $345 |
| Medicare [20244] | Hb Ada Medicare/Mgd Medicare 100% | $345 |
| Independent Health [20197] | Hb Ada Medicare/Mgd Medicare 100% | $345 |
| Horizons Medicare [20190] | Hb Ada Medicare/Mgd Medicare 100% | $345 |
| Generic Medicare Managed Care [20137] | Hb Ada Medicare/Mgd Medicare 1 | $345 |
| Health First Health Plans Medicare [20170] | Hb Ada Medicare/Mgd Medic | $345 |
| Cross Timbers Hospice [20098] | Hb Ada Medicare/Mgd Medicare 100% | $345 |
| Medical Associates Health [20444] | Hb Ada Medicare/Mgd Medicare 100% | $345 |
| Kindful Hospice [20434] | Hb Ada Medicare/Mgd Medicare 100% | $345 |
| Elara Caring Aspire Hospice [20433] | Hb Ada Medicare/Mgd Medicare 100 | $345 |
| Halo Hcr Inc Hospice [20432] | Hb Ada Medicare/Mgd Medicare 100% | $345 |
| Aetna Medicare Advantage Contracted [320010] | Hb Ada Medicare/Mgd Med | $345 |
| BCBS Medicare Advantage Contracted [320047] | Hb Ada Medicare/Mgd Medi | $345 |
| Humana Medicare Advantage Contracted [320194] | Hb Ada Humana Mcr Adva | $345 |
| Longevity Health Plan Medicare Contracted [320225] | Hb Ada Medicare/M | $345 |
| Indian Health Service Contracted [320198] | Hb Ada Medicare/Mgd Medica | $345 |
| Medica Medicare Advantage [20477] | Hb Ada Medica Medicare New 031523 | $352 |
| Mc Anthem [20455] | Hb Ada Blue Cross Choice | $356 |
| Mc Generic Anthem [20456] | Hb Ada Blue Cross Choice | $356 |
| Blue Cross And Blue Shield [20053] | Hb Ada Blue Cross Choice | $356 |
| Blue Cross And Blue Shield [20053] | Hb Ada Blue Cross Advantage PPO | $356 |
| Blue Cross And Blue Shield [20053] | Hb Ada Blue Cross Preferred | $356 |
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