CT abdomen and pelvis with contrast at WellSpan Surgery & Rehabilitation Hospital. CPT 74177.
What WellSpan Surgery & Rehabilitation Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$438cash price (self-pay)
$2,896list price
$241–$2,809range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| UPMC_Medicaid | All_Plans | $241 |
| Highmark_Wholecare_Gateway_Medicaid | All_Plans | $329 |
| Geisinger_Medicaid | All_Plans | $329 |
| Health_Partners_Medicaid | All_Other_Plans | $329 |
| PA_Health_&_Wellness_Medicaid | All_Plans | $329 |
| Blue_Cross_BlueJourney_Medicare | All_Plans | $346 |
| Johns_Hopkins_HealthCare_Plan | Johns_Hopkins_US_Family_Health | $346 |
| Highmark_Medicare | All_Plans | $349 |
| Aetna_Advantra_Medicare | All_Plans | $356 |
| Aetna_Medicare | All_Plans | $356 |
| Geisinger_Gold_Medicare | All_Plans | $363 |
| Devoted_Medicare | All_Plans | $363 |
| Highmark_Wholecare_Gateway_Medicare | All_Plans | $365 |
| Amerihealth_Medicare | All_Plans | $365 |
| Jefferson_Health_Medicare_Advantage | All_Plans | $373 |
| PA_Health_&_Wellness_Medicare | All_Plans | $373 |
| Amerihealth_Caritas_Medicaid | All_Plans | $374 |
| WellSpan_Capital_Blue_Cross | All_Plans | $395 |
| UPMC_Medicare | UPMC_for_Life_Community_HealthChoices | $417 |
| UPMC_Medicare | UPMC_for_Life_Complete_Care | $417 |
| Highmark | Higmark_Healthy_Kids | $529 |
| Health_Partners_Medicaid | Kidz_Partners | $570 |
| United_Medicaid | Community_Plan_For_Kids | $605 |
| Aetna_Better_Health_Kids | All_Plans | $895 |
| Highmark | Choice_Blue_PPO | $1,353 |
| Highmark | Performance_Blue | $1,353 |
| Highmark | Blue_Cross_High_Performance_Network | $1,353 |
| Blue_Cross | Capital_Cares_4_kids | $1,626 |
| Highmark | All_Other_Plans | $1,722 |
| United_Healthcare | All_Plans | $2,107 |
Inpatient
$438cash price (self-pay)
$2,896list price
$1,676–$2,751range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue_Cross | Capital_Blue_Performance_PPO | $1,676 |
| Blue_Cross | Capital_Cares_4_kids | $1,711 |
| Aetna | All_Plans | $2,563 |
| First_Health_Network | All_Plans | $2,563 |
| Cigna | All_Plans | $2,596 |
| Blue_Cross | All_Other_Plans | $2,596 |
| UPMC | UPMC_For_Kids | $2,693 |
| UPMC | All_Plans | $2,693 |
| Geisinger | All_Plans | $2,712 |
| Johns_Hopkins_HealthCare_Plan | All_Other_Plans | $2,751 |
| PHC | All_Plans | $2,751 |
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All common services at WellSpan Surgery & Rehabilitation Hospital