CT abdomen and pelvis with contrast at UPMC Carlisle. CPT 74177.
What UPMC Carlisle publishes for this service, straight from its standard-charges file, last updated March 6, 2026.
Outpatient / ER
$2,986cash price (self-pay)
$4,976list price
$252–$4,230range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| United Healthcare Community Plan for Families | PA Medicaid | $252 |
| Premier Comp Solutions | Worker's Comp | $280 |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $334 |
| Highmark Wholecare (prev Gateway) | Medicaid | $334 |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue | $338 |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $338 |
| Humana | Medicare | $342 |
| UPMC Health Plan | Managed Medicaid | $342 |
| Aetna | Medicare | $356 |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $358 |
| Cigna | Medicare | $359 |
| Geisinger | Medicare | $359 |
| United Healthcare | Medicare | $366 |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advant | $369 |
| Geisinger | Medicaid/CHIP | $383 |
| PA Health & Wellness | PA Medicaid HMO | $448 |
| UPMC Work Partners | Workers Comp | $525 |
| Keystone Autism Services | ACAP | $547 |
| Prime Net | Managed Medicare | $943 |
| Highmark BCBS of PA | Community Blue PPO | $961 |
| Capital Blue Cross | Medicare Advantage | $995 |
| Keystone Health Plan | Medicare Advantage | $995 |
| Highmark BCBS of PA | CHIP - Managed Care | $1,002 |
| Highmark BCBS of PA | Commercial | $1,068 |
| Prime Net | Legacy Commercial | $1,941 |
| Aetna | ACO | $1,956 |
| Prime Net | ACO | $1,956 |
| Cigna | Commercial | $2,007 |
| Prime Net | NonGateKeeper | $2,314 |
| Aetna | Commercial | $2,329 |
Inpatient
$2,986cash price (self-pay)
$4,976list price
$2,030–$4,230range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Prime Net | Legacy Commercial | $2,030 |
| Aetna | ACO | $2,045 |
| Prime Net | ACO | $2,045 |
| Prime Net | NonGateKeeper | $2,418 |
| Aetna | Commercial | $2,433 |
| Prime Net | GateKeeper | $2,433 |
| Geisinger | Commercial | $3,594 |
| Prime Net | FH-Medical Rental | $3,762 |
| Wellspan Population Health | PPO | $3,981 |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $4,230 |
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