CMS Price Transparency Data

CT scan, abdomen and pelvis (no contrast)

Facility: Kenmore Mercy Hospital

Billing Code: 74176 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74176
Insurance Median: $189
Cash Discount Price: $194
vs. Medicare Baseline: 0.78x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (no contrast) at Kenmore Mercy Hospital is $189. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $194. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 0.78x the Medicare baseline. Located in 2950 Elmwood Avenue, Kenmore, NY.

Cash / Self-Pay

$194

Average discount available for prompt cash payment at this facility.

Insurance Median

$189

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)

Cash / Self-Pay: $194 (80%)

Insurance Median: $189 (78%)

Cash: $194 (80% of Medicare)

Ins. Median: $189 (78% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
UnitedHealthcare	$42 - $189	17%
Univera Healthcare Essential [100170]	$50 - $157	21%
Blue Cross Blue Shield	$94 - $310	39%
Molina Essential [100167]	$94 - $293	39%
Fidelis Essential [100163]	$94 - $198	39%
Hospice [550001]	$101 - $180	41%
Amerigroup [350102]	$102 - $310	42%
Medicare (plans)	$103 - $377	42%
Vna Option Mltc [350110]	$130	53%
Medicaid / KanCare	$130 - $260	53%
Excellus Rochester McD [350117]	$130	53%
Tuscarora Nation [550120]	$130	53%
Crime Victims [100176]	$130	53%
Independent Health Essential [100166]	$130 - $312	53%
VA Veterans Affairs [700001]	$153	63%
Univera Healthcare [100169]	$157 - $222	64%
Beacon Essential [350122]	$162 - $216	66%
Ghi [100153]	$171	70%
Covid19 Hrsa [45013]	$180	74%
Cigna	$180 - $261	74%
Champ VA [700002]	$180	74%
Seneca Nation [450119]	$180	74%
Tricare	$180	74%
Catholic Health Life Pace [400005]	$180	74%
Fallon Health [450115]	$180	74%
Humana	$189	78%
Aetna	$189	78%
Wellcare Fidelis Dual [450451]	$189	78%
Fidelis Dual Advantage [450120]	$189	78%
Independent Health [100165]	$196 - $624	80%
Iha First Choice [800001]	$196 - $588	80%
Wellcare [450129]	$198	81%
No Fault [114001]	$208 - $330	85%
Beacon Health Options [100023]	$216	89%
Fidelis Exchange [100164]	$216	89%
Mvp Healthcare [100168]	$243	100%
UPMC Health Plan [100181]	$324	133%
Federal Workers Compensation [500100]	$330	135%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $194.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 74176.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Kenmore Mercy Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 74176.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.