CT abdomen and pelvis with contrast at Mercy Hospital Oklahoma City. CPT 74177.
What Mercy Hospital Oklahoma City publishes for this service, straight from its standard-charges file, last updated June 12, 2026.
Outpatient / ER
$3,116cash price (self-pay)
$4,794list price
$189–$4,794range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medicaid [20240] | Hb Oklc Ok Medicaid (Soonercare) | $189 |
| Aetna Medicaid Contracted [320009] | Hb Oklc Ok Medicaid (Soonercare) | $189 |
| Humana Medicaid Contracted [320486] | Hb Oklc Ok Medicaid (Soonercare) | $189 |
| Oklahoma Complete Health Medicaid Contracted [320485] | Hb Oklc Ok Med | $189 |
| Aetna Contracted [320008] | Hb Oklc Aetna Preferred Cox & Nbd | $192 |
| Aetna Contracted [320008] | Hb Oklc Aetna POS HMO Gated | $192 |
| Medicaid [20240] | Hb Oklc Ark Medicaid | $206 |
| Tricare [20380] | Hb Oklc Managed Medicare | $306 |
| Prominence Health Plan Medicare Advantage Contracted [320496] | Hb Okl | $323 |
| Provider Partners Health Plans Contracted [320450] | Hb Oklc Managed M | $323 |
| American Health Advantage Of Ok Medicare [20019] | Hb Oklc Managed Med | $323 |
| Longevity Health Plan [10477] | Hb Oklc Managed Medicare | $323 |
| BCBS Medicare Advantage [20047] | Hb Oklc Managed Medicare | $323 |
| Medicare [20244] | Hb Oklc Medicare | $323 |
| Mercy Hospice Okc [20252] | Hb Oklc Managed Medicare | $323 |
| Champva [20065] | Hb Oklc Managed Medicare | $323 |
| Generic Medicare Managed Care [20137] | Hb Oklc Managed Medicare | $323 |
| Cross Timbers Hospice [20098] | Hb Oklc Managed Medicare | $323 |
| Elara Caring Aspire Hospice [20433] | Hb Oklc Managed Medicare | $323 |
| Medica Medicare Advantage Contracted [320477] | Hb Oklc Medica Medicar | $329 |
| Globalhealth Medicare Advantage [20145] | Hb Oklc Managed Medicare | $329 |
| Healthspring Medicare Advantage Contracted [320526] | Hb Oklc Cigna Mc | $332 |
| Devoted Health Medicare Contracted [320500] | Hb Oklc Devoted Health M | $342 |
| Amg Spec Hosp Edmond [20034] | Hb Oklc Ltac Mcr 105% | $345 |
| Blue Cross And Blue Shield [20053] | Hb Oklc Blue Choice | $356 |
| Blue Cross And Blue Shield [20053] | Hb Oklc Blue Cross Advantage PPO | $356 |
| Blue Cross And Blue Shield [20053] | Hb Oklc Blue Cross Preferred | $356 |
| Mc Generic Anthem [20456] | Hb Oklc Blue Choice | $356 |
| Mc Anthem [20455] | Hb Oklc Blue Choice | $356 |
| Ambetter Contracted [320452] | Hb Oklc Ambetter Exchange Medicare | $444 |
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