CT abdomen and pelvis with contrast at UPMC Wellsboro. CPT 74177.
What UPMC Wellsboro publishes for this service, straight from its standard-charges file, last updated March 6, 2026.
Outpatient / ER
$4,453cash price (self-pay)
$7,077list price
$247–$7,051range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| United Healthcare Community Plan for Families | PA Medicaid | $247 |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $289 |
| Geisinger | Medicaid/CHIP | $289 |
| UPMC Health Plan | CHIP | $289 |
| UPMC Health Plan | Managed Medicaid | $289 |
| Highmark Wholecare (prev Gateway) | Medicaid | $293 |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $397 |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $448 |
| UPMC Work Partners | Workers Comp | $502 |
| Aetna | Medicare | $1,274 |
| Highmark BCBS of PA | Medicare | $1,415 |
| Highmark Wholecare (prev Gateway) | Medicare | $1,415 |
| UPMC Health Plan | Managed Medicare | $1,444 |
| Cigna | Medicare | $1,486 |
| United Healthcare | Medicare | $1,514 |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advant | $1,529 |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $3,039 |
| UPMC Health Plan | Commercial | $3,086 |
| Highmark BCBS of PA | Commercial | $3,579 |
| Wirerope Works | Commercial | $3,935 |
| Geisinger | Commercial | $4,742 |
| Aetna | PEBTF Custom Network | $5,192 |
| Multiplan | Auto | $5,520 |
| Multiplan | PPO (Includes PHCS as a Payer) | $5,520 |
| United Healthcare | Commercial | $6,015 |
| Aetna | Commercial | $6,107 |
| America's Choice | PPO | $6,369 |
| InterGroup | PPO | $6,369 |
| Multiplan | Worker's Compensation | $6,723 |
Inpatient
$4,453cash price (self-pay)
$7,077list price
$3,743–$7,051range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Wirerope Works | Commercial | $3,935 |
| Aetna | PEBTF Custom Network | $5,192 |
| Multiplan | Auto | $5,520 |
| Multiplan | PPO (Includes PHCS as a Payer) | $5,520 |
| United Healthcare | Commercial | $6,015 |
| Aetna | Commercial | $6,107 |
| America's Choice | PPO | $6,369 |
| InterGroup | PPO | $6,369 |
| Multiplan | Worker's Compensation | $6,723 |
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