CT abdomen and pelvis with contrast at Wayne Memorial Hospital. CPT 74177.
What Wayne Memorial Hospital publishes for this service, straight from its standard-charges file, last updated September 16, 2026.
Outpatient / ER
$5,711cash price (self-pay)
$8,159list price
$371–$6,527range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| MEDICARE ADVANTAGE 100Percentage | MEDICARE ADVANTAGE 100Percentage | $371 |
| Humana | Humana | $375 |
| Upmc Medicare | Upmc Medicare | $386 |
| Ambetter | AMBETTER | $393 |
| Pa Health & Wellness | Pa Health Wellness | $393 |
| WELLPATH (State Prison) | WELLPATH (State Prison) | $482 |
| WELLPATH (Federal Prison) | WELLPATH (Federal Prison) | $686 |
| Blue Cross | Blue Cross | $3,264 |
| KeyStone First | KEYSTONE FIRST | $3,264 |
| Upmc | Upmc | $4,406 |
| Geisinger | Geisinger | $5,630 |
| Cigna | Cigna | $5,711 |
| Phcs | Phcs | $5,711 |
| Self-Pay | Self-Pay | $5,711 |
| UHC | UHC | $5,711 |
| Aetna | Aetna | $6,119 |
| MultiPlan | MULTIPLAN | $6,527 |
Inpatient
$5,711cash price (self-pay)
$8,159list price
$3,264–$6,527range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| KeyStone First | KEYSTONE FIRST | $3,264 |
| Phcs | Phcs | $5,711 |
| Self-Pay | Self-Pay | $5,711 |
| MultiPlan | MULTIPLAN | $6,527 |
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