CT abdomen and pelvis with contrast at Roxborough Memorial Hospital. CPT 74177.
What Roxborough Memorial Hospital publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$356cash price (self-pay)
$5,818list price
$193–$5,643range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Health Partners Plan | Health Partners Plan Medicaid | $193 |
| Traditional Medicaid | Traditional Medicaid | $193 |
| Keystone | Keystone First Medicaid | $204 |
| UHC | UHC Medicaid | $218 |
| Humana Military Tricare | Humana Military Tricare | $285 |
| Health Partners Plan | Health Partners Plan Medicare | $357 |
| Independence Blue Cross | IBC Medicare | $357 |
| PA Health & Wellness | PA Health & Wellness Medicare & Duals | $357 |
| Traditional Medicare | Traditional Medicare | $357 |
| Tricare | Tricare | $357 |
| UHC | UHC Medicare | $357 |
| UHC | UHC Va Ccn | $357 |
| Providers Partner Health Plan | Provider Partners Health Plan | $367 |
| Keystone | Keystone First Medicare | $371 |
| Ally-Align Medicare | Ally-Align Medicare | $374 |
| Spartan | Spartan Plan | $374 |
| Auto Insurance | Auto Insurance | $392 |
| Worker Compensation | Worker Compensation | $403 |
| PA Health & Wellness | PA Health & Wellness Commercial Insurance Excha | $428 |
| Employer Direct Healthcare | Employer Direct Healthcare | $499 |
| Health Partners Plan | Health Partners Plan Exchange | $535 |
| Naphcare | Naphcare | $553 |
| UHC | UHC Exchange | $561 |
| UHC | UHC Commercial All Payer | $745 |
| Independence Blue Cross | IBC Commercial HMO PPO | $772 |
| Independence Blue Cross | IBC Indemnity | $772 |
| Highmark | Highmark Commercial (02-01-2024 to 12-31-2026) | $777 |
| Cigna | Cigna Commercial (05-01-2023 to 12-31-2026) | $843 |
| Independence Blue Cross | IBC PPACA | $848 |
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