CT abdomen and pelvis with contrast at Pennsylvania Hospital. CPT 74177.
What Pennsylvania Hospital publishes for this service, straight from its standard-charges file, last updated March 20, 2026.
Outpatient / ER
$14,153cash price (self-pay)
$14,153list price
$193–$14,153range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Managed Medicaid Other | Managed Medicaid Other | $193 |
| PA Health and Wellness Medicaid | PA Health and Wellness Medicaid | $222 |
| Keystone Mercy Health Plan | Keystone Mercy Health Plan | $247 |
| PA Medical Assistance | Medicaid | $263 |
| UPMC | UPMC Medicaid | $288 |
| Keystone HMO Proactive | Keystone HMO Proactive | $348 |
| Independence Blue Cross/Keystone Health Plan East | Keystone Health Pl | $348 |
| IBC Commercial HPN | IBC Commercial HPN | $360 |
| TriCare | TriCare | $367 |
| UnitedHealthcare Community (fka AmeriChoice MA) | UnitedHealthcare Com | $380 |
| UnitedHealthcare | UnitedHealthcare Compass Exchange | $407 |
| US Family Health Plan | US Family Health Plan | $422 |
| Horizon Blue Cross of New Jersey | Horizon Blue Cross of NJ-PPO | $631 |
| Horizon Blue Cross of New Jersey | Horizon Blue Cross of NJ-Indemnity | $631 |
| Independence Blue Cross/Personal Choice | Personal Choice-IBC PPO | $688 |
| UnitedHealthcare New Business | UnitedHealthcare New Business | $864 |
| UnitedHealthcare Non Options | UnitedHealthcare Non Options | $1,219 |
| Horizon NJ Health | Horizon NJ Health | $2,488 |
| PGM - Regie de l'assurance Maladie Quebec | PGM - Regie de lassurance | $3,255 |
| Preferred Health Care Eliance | Preferred Health Care Eliance | $3,680 |
| Independence Blue Cross | IBC Traditional | $4,386 |
| PGM - Kuwait Defense | PGM - Kuwait Defense | $4,954 |
| Qualcare | Qualcare | $5,378 |
| Wissahickon Hospice | Wissahickon Hospice | $5,661 |
| Pgm - Chop | Pgm - Chop | $5,661 |
| Olympus | Olympus | $6,878 |
| URN-Cancer Resource Services | URN-Cancer Resource Services | $7,077 |
| PGM - Royal Embassy of Saudi Arabia | PGM - Royal Embassy of Saudi Ara | $8,492 |
| PGM - Ontario Ministry of Health and Long-Term Care (OHIP) | PGM - Ont | $9,199 |
| PGM - Embassy of Qatar | PGM - Embassy of Qatar | $9,199 |
Inpatient
$14,153cash price (self-pay)
$14,153list price
$2,392–$14,153range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Horizon NJ Health | Horizon NJ Health | $2,392 |
| PGM - Regie de l'assurance Maladie Quebec | PGM - Regie de lassurance | $3,255 |
| Preferred Health Care Eliance | Preferred Health Care Eliance | $3,680 |
| Devon | Devon Premier | $5,378 |
| Pgm - Chop | Pgm - Chop | $5,661 |
| Coventry | HealthAmerica/Coventry SEPA | $5,661 |
| PGM - Kuwait Defense | PGM - Kuwait Defense | $6,369 |
| HealthAmerica/Coventry | HealthAmerica/HealthAssurance | $6,935 |
| URN-Cancer Resource Services | URN-Cancer Resource Services | $7,077 |
| First Health Global | First Health Global | $7,077 |
| Coventry | Coventry of Delaware | $7,218 |
| PGM - Royal Embassy of Saudi Arabia | PGM - Royal Embassy of Saudi Ara | $8,492 |
| Health Net | Health Net | $8,492 |
| PGM - Ontario Ministry of Health and Long-Term Care (OHIP) | PGM - Ont | $9,199 |
| Preferred Care | Preferred Care | $11,322 |
| PGM - Kuwait Oil | PGM - Kuwait Oil | $11,322 |
| PGM - Kuwait Health Division | PGM - Kuwait Health Division | $11,322 |
| Intergroup | Intergroup | $11,322 |
| Humana Choice Care | Humana Choice Care | $11,322 |
| Health America/CCN | First Health/ Coventry National | $11,322 |
| Devon Health Services Inc | Devon Health Services | $11,322 |
| UPMC | UPMC Medicaid | $14,153 |
| UnitedHealthcare Non Options | UnitedHealthcare Non Options | $14,153 |
| United Behavioral Health | United Behavioral Health | $14,153 |
| Quest Behavioral Health | Quest Behavioral Health | $14,153 |
| Managed Medicaid Other | Managed Medicaid Other | $14,153 |
| International PFS | International PFS | $14,153 |
| Horizon Blue Cross of New Jersey | Horizon Blue Cross of NJ-PPO | $14,153 |
| Horizon Blue Cross of New Jersey | Horizon Blue Cross of NJ-Indemnity | $14,153 |
| Health Partners | Health Partners Medicaid | $14,153 |
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