CT abdomen and pelvis with contrast at Highland Hospital Of Rochester. CPT 74177.
What Highland Hospital Of Rochester publishes for this service, straight from its standard-charges file, last updated July 1, 2026.
Outpatient / ER
$414cash price (self-pay)
$3,153list price
$109–$1,319range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| United Healthcare Medicaid [1716] | United Healthcare Medicaid [171601 | $109 |
| Amerigroup (Bswny Alternate) [1720] | Amerigroup (Bswny Alternate) [17 | $109 |
| Excellus Medicaid [1706] | Blue Choice Option Medicaid [170601] | $109 |
| Excellus [2201] | Excellus Child Health Plus [220108] | $109 |
| Excellus [2201] | Excellus Essential (No Medicaid) [220109] | $109 |
| Excellus Medicaid [1706] | Excellus Essential (W/ Medicaid) [170604] | $109 |
| United Healthcare [5158] | United Healthcare Essential (No Medicaid [5 | $109 |
| Molina Healthcare [5189], Molina Healthcare [1723] | Molina Child Heal | $109 |
| Molina Healthcare [5189], Molina Healthcare [1723] | Molina Essential | $109 |
| Mvp [2900] | Mvp Child Health Plus [290004] | $124 |
| Mvp Medicaid [1712] | Mvp Option Medicaid [171201] | $124 |
| Fidelis [5155], Fidelis Medicaid [1708] | Fidelis Child Health Plus [5 | $164 |
| Mvp [2900] | Mvp Essential (No Medicaid) [290005] | $223 |
| Fidelis [5155] | Fidelis Metal Tiers [515501] | $240 |
| Fidelis [5155] | Fidelis Essential (No Medicaid) [515503] | $245 |
| Fidelis Medicaid [1708] | Fidelis Essential (W/ Medicaid) [170804] | $245 |
| Medicare Blue Choice [1306] | Medicare Blue Choice [130601] | $387 |
| Bc/Bs Of Western NY Medicare [1301] | Highmark Bc/Bs Medicare [130101] | $423 |
| Fidelis Medicare [1311] | Fidelis Wellcare Medicare [131101] | $423 |
| Martins Point [1205] | Us Family Plan At Martin'S Point [120501] | $429 |
| Highmark Blue Cross Blue Shield Medicare [1301] | Highmark BCBS Medica | $435 |
| Fidelis Medicare [1311] | Fidelis Medicare [131101] | $435 |
| Cdphp Medicare [1320] | Cdphp Medicare [132001] | $447 |
| Cdphp Medicare [1320] | Capital District Physicians Medicare [132001] | $456 |
| United Healthcare Medicare [1309] | United Healthcare Medicare [130901 | $457 |
| Humana Medicare [1312] | Humana Medicare [131201] | $508 |
| Aetna Medicare [1300] | Aetna Medicare [130001] | $514 |
| Mvp Medicare [1307] | Mvp Medicare [130701] | $535 |
| Excellus Blue Cross Blue Shield [2201], Out Area Blue Cross Blue Shiel | $554 |
| Excellus [2201] | Excellus Metal Tiers [220102] | $596 |
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