CT abdomen and pelvis with contrast at HealthAlliance-Clinton, Leominster Campus. CPT 74177.
What HealthAlliance-Clinton, Leominster Campus publishes for this service, straight from its standard-charges file, last updated March 26, 2026.
Outpatient / ER
$4,789cash price (self-pay)
$4,816list price
$251–$4,816range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| GRANTS [20507] | All TB GETCHELL [226] Plans | $251 |
| HSNO/FREE CARE [10801] | All HSNO HA [89] Plans | $294 |
| CHAMPVA [11001] | All TRICARE / CHAMPVA HA [167] Plans | $382 |
| TUFTS DUAL [10111] | All TUFTS UNIFY HA [231] Plans | $423 |
| INSTITUTION [10406] | All HOSPICE HA [157] Plans | $423 |
| INSTITUTION [10406] | All HOSPICE GENERIC [237] Plans | $423 |
| MEDICARE [20206] | All MEDICARE/ MEDICARE ADV PLANS/ INST HA [98] Plan | $423 |
| TUFTS US FAMILY [11203] | All TUFTS US FAMILY HA [291] Plans | $423 |
| CORRECTIONAL CARE [11003] | All CORRECTIONAL CARE STATE HA [95] Plans | $423 |
| CORRECTIONAL CARE [11003] | All CORRECTIONAL CARE FORT DEVENS HA [162] | $423 |
| CIGNA MCR [10121] | All MEDICARE ADVANTAGE (MINUS IME) HA [134] Plans | $423 |
| MEDICAID [20301] | All MEDICAID OF CT [28] Plans | $423 |
| BCBS MCR [10102] | All BC MCR HA [66] Plans | $437 |
| COMMONWEALTH CARE MCR [10115] | All ONE CARE HA [224] Plans | $444 |
| AETNA MCR [10101] | All MEDICARE ADV AT 105% HA [244] Plans | $444 |
| TUFTS MCR [10112] | All TUFTS MCR HA [249] Plans | $444 |
| FALLON MCR SUPP [20202] | All FALLON SENIOR HA [112] Plans | $444 |
| MGB MCR [10124] | All MGB MCR HA [313] Plans | $444 |
| UHC DUAL [10118] | All UHC COMMUNITY CARE SCO (EVERCARE) HA [229] Plan | $444 |
| HARVARD PILGRIM MCR [10106] | All HARVARD PILGRIM MCR HA [143] Plans | $444 |
| SENIOR WHOLE HEALTH [10110] | All SENIOR WHOLE HEALTH HA [131] Plans | $453 |
| UHC MCR REPLACE AARP [10114] | All UHC MCR HA [318] Plans | $453 |
| TUFTS CONNECTORCARE [10507] | All TUFTS CONNECTORCARE/DIRECT QHP HA [1 | $720 |
| WELLPOINT [11112] | All WELLPOINT (UNICARE) HA [57] Plans | $953 |
| TUFTS [11201] | All TUFTS HMO HA [173] Plans | $971 |
| CIGNA CARELINK [11202] | All TUFTS PPO/CARELINK HA [174] Plans | $1,068 |
| BCBS [10301] | All BC PPO HA [58] Plans | $1,069 |
| BCBS [10301] | All BC HMO HA [61] Plans | $1,069 |
| UHC MEDICAID [11130] | All UHC RHODY PARTNERS [271] Plans | $1,633 |
| UHC [11111] | All UHC HA [125] Plans | $2,586 |
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All common services at HealthAlliance-Clinton, Leominster Campus