CT abdomen and pelvis with contrast at WellSpan Waynesboro Hospital. CPT 74177.
What WellSpan Waynesboro Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$438cash price (self-pay)
$4,340list price
$95.44–$4,123range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Health_Partners_Medicaid | All_Other_Plans | $95.44 |
| UPMC_Medicare | UPMC_for_Life_Community_HealthChoices | $276 |
| UPMC_Medicare | UPMC_for_Life_Complete_Care | $276 |
| UPMC_Medicaid | All_Plans | $278 |
| Highmark_Wholecare_Gateway_Medicaid | All_Plans | $329 |
| Geisinger_Medicaid | All_Plans | $329 |
| PA_Health_&_Wellness_Medicaid | All_Plans | $329 |
| Amerihealth_Caritas_Medicaid | All_Plans | $374 |
| PA_Health_&_Wellness_Medicare | All_Plans | $380 |
| Blue_Cross_BlueJourney_Medicare | All_Plans | $381 |
| Highmark | All_Other_Plans | $381 |
| Jefferson_Health_Medicare_Advantage | All_Plans | $381 |
| United_Medicaid | Community_Plan_For_Kids | $381 |
| Highmark_Medicare | All_Plans | $385 |
| Aetna_Advantra_Medicare | All_Plans | $392 |
| Aetna_Medicare | All_Plans | $392 |
| WellSpan_Capital_Blue_Cross | All_Plans | $395 |
| Devoted_Medicare | All_Plans | $400 |
| United_Medicare | ISNP_DSNP_Plans | $400 |
| Highmark_Wholecare_Gateway_Medicare | All_Plans | $402 |
| Amerihealth_Medicare | All_Plans | $402 |
| Geisinger_Gold_Medicare | All_Plans | $476 |
| Highmark | Higmark_Healthy_Kids | $583 |
| Health_Partners_Medicaid | Kidz_Partners | $628 |
| Highmark | My_Direct_Blue | $1,284 |
| Highmark | Shared_Cost_Blue_PPO | $1,284 |
| Aetna_Better_Health_Kids | All_Plans | $1,295 |
| Highmark | Choice_Blue_PPO | $1,461 |
| Highmark | Performance_Blue | $1,461 |
| Highmark | Blue_Cross_High_Performance_Network | $1,461 |
Inpatient
$438cash price (self-pay)
$4,340list price
$2,604–$4,123range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| UPMC | UPMC_For_Kids | $2,604 |
| Cigna | All_Plans | $3,181 |
| Aetna | All_Plans | $3,203 |
| Geisinger | All_Plans | $3,212 |
| Cigna | PPO_Plan | $3,340 |
| First_Health_Network | All_Plans | $4,123 |
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