CT abdomen and pelvis with contrast at Jefferson Lansdale Hospital. CPT 74177.
What Jefferson Lansdale Hospital publishes for this service, straight from its standard-charges file, last updated September 15, 2026.
Outpatient / ER
$402cash price (self-pay)
$4,877list price
$193–$3,830range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Jefferson Health Plan Medicaid | JAB002 Caid MCO CHIP | $256 |
| Keystone First | JAB002 Caid MCO | $280 |
| Keystone First | JAB002 Caid CHIP | $280 |
| PA Health and Wellness CHC | JAB002 CHC | $296 |
| Jefferson Health Plan ACA QHP Exchange | JAB002 Commercial Exchange | $299 |
| St Agnes | Medicare | $308 |
| Geisinger Medicaid | JAB002 Caid | $308 |
| Point of Comfort Refugee Resettlement | Commercial | $315 |
| Inspira Life | JAB002 Medicare | $315 |
| Innovage | JAB002 Medicare | $315 |
| IBC Medicare | JAB002 Medicare | $315 |
| Horizon Medicare Blue | JAB002 Medicare | $315 |
| Optum VA CCN | JAB002 VA CCN | $315 |
| VA_Champus_Tricare | JAB002 Military | $315 |
| Provider Partners Health Plan | JAB002 Medicare | $315 |
| Humana Medicare | JAB002 Medicare | $321 |
| Jefferson Health Plan Medicare | JAB002 Medicare | $321 |
| United Healthcare Medicare | Medicare ISNP | $321 |
| United Healthcare Medicare | JAB002 AARP | $321 |
| Cigna HealthSpring Medicare Adv | JAB002 Medicare | $327 |
| Devoted Health Participation | JAB002 Medicare | $331 |
| Highmark Medicare Advantage | JAB002 Medicare | $331 |
| Aetna Medicare Adv | JAB002 Medicare | $334 |
| Keystone First VIP Choice | JAB002 Medicare | $337 |
| United Healthcare Medicare | Medicare Group Retiree | $340 |
| UPMC Medicare Advantage | JAB002 Medicare | $346 |
| PA Health and Wellness Medicare | JAB002 Medicare | $346 |
| Geisinger Medicare Advantage | JAB002 Medicare | $362 |
| Perennial | JAB002 Medicare | $365 |
| Highmark Wholecare Gateway | JAB002 Medicare | $368 |
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