CT abdomen and pelvis with contrast at Jefferson Hospital. CPT 74177.
What Jefferson Hospital publishes for this service, straight from its standard-charges file, last updated April 14, 2026.
Outpatient / ER
$46.17cash price (self-pay)
$2,581list price
$70.54–$2,042range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Univera | Univera Essential Plan | $217 |
| Univera | Univera Healthy New York | $217 |
| Highmark | Highmark Together Blue | $252 |
| Univera | Univera Medicare | $269 |
| Highmark | Highmark My Direct Blue | $282 |
| University of Pittsburgh Medical Center | University of Pittsburgh Med | $303 |
| United Healthcare | United Healthcare Medicaid | $308 |
| Univera | Univera Commercial | $315 |
| Aetna | Aetna Better Health CHIP | $316 |
| Highmark | Highmark Community Blue Medicare PPO | $316 |
| Highmark | Highmark Complete Blue Medicare | $316 |
| Highmark | Highmark Freedom Blue | $320 |
| Highmark | Highmark Blue High Performance | $336 |
| Highmark | Highmark Community Blue | $336 |
| Highmark | Highmark Connect Blue | $336 |
| Highmark | Highmark Indemnity | $336 |
| Highmark | Highmark Managed Care | $336 |
| Highmark | Highmark My Blue Access | $336 |
| Highmark | Highmark Performance Blue | $336 |
| Highmark | Highmark Social Mission Indemnity | $336 |
| Highmark | Highmark Social Mission Managed Care | $336 |
| American Health Plans | American Health Plans Medicare | $344 |
| Devoted Medicare | Devoted Health Medicare Advantage | $354 |
| Aetna | Aetna Medicare | $357 |
| Highmark | Highmark Community Blue Medicare HMO | $357 |
| Highmark | Highmark Security Blue | $357 |
| Amerihealth | Amerihealth Caritas D-SNP Medicare | $361 |
| Highmark Wholecare | Highmark Wholecare Medicaid HC | $363 |
| Geisinger | Geisinger CHIP | $365 |
| Geisinger | Geisinger Medicaid HC | $365 |
Inpatient
$3,984cash price (self-pay)
$4,919list price
$70.54–$601range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Amerihealth | Amerihealth Caritas D-SNP Medicare | $73.95 |
| Amerihealth | Amerihealth Caritas Medicare (NY) | $73.95 |
| Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $92.97 |
| Amerihealth | Amerihealth Caritas CHC Medicaid | $102 |
| Amerihealth | Amerihealth Caritas HC Medicaid | $102 |
| Geisinger | Geisinger CHIP | $102 |
| Geisinger | Geisinger Medicaid HC | $102 |
| United Healthcare | United Healthcare Medicaid | $102 |
| Univera | Univera Essential Plan | $182 |
| Univera | Univera Healthy New York | $182 |
| Univera | Univera Medicare | $225 |
| Univera | Univera Commercial | $264 |
| Highmark | Highmark Together Blue | $265 |
| Highmark | Highmark Blue High Performance | $280 |
| Highmark | Highmark Community Blue | $280 |
| Highmark | Highmark Connect Blue | $280 |
| Highmark | Highmark Indemnity | $280 |
| Highmark | Highmark Managed Care | $280 |
| Highmark | Highmark My Blue Access | $280 |
| Highmark | Highmark My Direct Blue | $280 |
| Highmark | Highmark Performance Blue | $280 |
| Highmark | Highmark Social Mission Indemnity | $280 |
| Highmark | Highmark Social Mission Managed Care | $280 |
| Cigna | Cigna Commercial | $346 |
| United Healthcare | United Healthcare Navigate Nexus Commercial | $404 |
| United Healthcare | United Healthcare Of OH Medicaid | $426 |
| United Healthcare | United Healthcare Commercial | $426 |
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