CT abdomen and pelvis with contrast at UPMC Lititz. CPT 74177.
What UPMC Lititz 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 | Medicare | $340 |
| UPMC Health Plan | Managed Medicaid | $342 |
| Aetna | Medicare | $358 |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $358 |
| Cigna | Medicare | $360 |
| Geisinger | Medicare | $360 |
| United Healthcare | Medicare | $367 |
| Geisinger | Medicaid/CHIP | $383 |
| UPMC Work Partners | Workers Comp | $525 |
| Keystone Autism Services | ACAP | $549 |
| Prime Net | Managed Medicare | $935 |
| Capital Blue Cross | Medicare Advantage | $995 |
| Keystone Health Plan | Medicare Advantage | $995 |
| Highmark BCBS of PA | Commercial - Children's Health Insurance | $1,014 |
| Highmark BCBS of PA | Medicaid | $1,056 |
| Highmark BCBS of PA | Commercial | $1,079 |
| 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 |
| Prime Net | GateKeeper | $2,329 |
| Capital Blue Cross | CHIP | $2,334 |
| Capital Blue Cross | Commercial | $2,334 |
| Keystone Health Plan | Commercial | $2,334 |
Inpatient
$2,986cash price (self-pay)
$4,976list price
$1,846–$4,230range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Prime Net | Legacy Commercial | $1,846 |
| Aetna | ACO | $1,861 |
| Prime Net | ACO | $1,861 |
| Prime Net | NonGateKeeper | $2,199 |
| Aetna | Commercial | $2,214 |
| Prime Net | GateKeeper | $2,214 |
| Preferred Healthcare System | Inter County Health Plan/Lancaster Gener | $2,737 |
| Geisinger | Commercial | $3,594 |
| Prime Net | FH-Medical Rental | $3,603 |
| Preferred Healthcare System | PPO | $3,732 |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $4,230 |
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