CT abdomen and pelvis with contrast at Kenmore Mercy Hospital. CPT 74177.
What Kenmore Mercy Hospital publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$64.76cash price (self-pay)
$531list price
$57.18–$1,071range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Univera Healthcare Essential [100170] | Univera Essential Plan 3 And 4 | $70.54 |
| Univera Healthcare Essential [100170] | Univera Essential Plan 1 And 2 | $78.49 |
| Molina Medicaid [350107] | Affinity Molina Chp Non-Medicaid [35010704] | $88.74 |
| Fidelis Medicaid [350105] | Child Health Plus Fidelis Medicaid [350105 | $91.45 |
| Beacon Medicaid Replacement Alt [350124] | Beacon Essential 3 And 4 Al | $91.45 |
| Fidelis Medicaid [350105] | Fidelis Mltc [35010504] | $91.45 |
| Amerigroup Medicaid [350002] | Amerigroup Medicaid [35000201] | $92.53 |
| Medicaid In State [300001] | Nys Medical Assistance [30000102] | $92.53 |
| Medicaid Out Of State [309999] | Medicaid Massachusetts [30999906] | $92.53 |
| Medicaid Out Of State [309999] | Medicaid Out Of State [30999901] | $92.53 |
| Tuscarora Nation [550120] | Tuscarora Nation Plan [55012005] | $92.53 |
| Medicaid HMO Other Nys [350104] | Medicaid HMO Other Nys [35010401] | $92.53 |
| Medicaid In State [300001] | Medicaid In State [30000101] | $92.53 |
| Medicaid In State Alt Payer [300002] | School Medicaid Alt [30000201] | $92.53 |
| Medicaid Out Of State [309999] | Medicaid Maine [30999907] | $92.53 |
| Univera Healthcare Essential [100170] | Univera Essential Plan 200-250 | $105 |
| United Healthcare Essential [100253] | UHC Essential 3 And 4 [10025302 | $147 |
| United Healthcare Essential [100253] | UHC Essential 1 And 2 [10025301 | $147 |
| BCBS Essential [100152] | Bc Essential Plan 1 And 2 [10015201] | $170 |
| BCBS Essential [100152] | Bc Essential Plan 200-250 [10015203] | $170 |
| Fidelis Essential [100163] | Fidelis Essential Plan 1 And 2 [10016301] | $182 |
| Independent Health Medicare [450122] | Mcr Passport Advantage [4501220 | $362 |
| No Fault [114001] | Liberty Mutual Ins [11400108] | $385 |
| NO FAULT [114001] | The Hartford [11500102] | $385 |
| No Fault [114001] | Travelers Ins [11400106] | $385 |
| Workers Compensation [500101] | Aig Claims [50010104] | $385 |
| Workers Compensation [500101] | Broadspire Ins [50010110] | $385 |
| Workers Compensation [500101] | Comp Management Inc [50010115] | $385 |
| Workers Compensation [500101] | Pma Management Group [50010114] | $385 |
| Workers Compensation [500101] | First Niagara Risk [50010109] | $385 |
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