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Freeway tolls in Italy

Can you use a credit card to pay tolls in Italy, or do you have to use cash?

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You can use credit cards. However the toll gates that accept credit cards are unmanned so you will need to follow the automatic machine prompts. No PIN is necessary.
The toll gates with a live person accept only cash. Manned toll gates are marked by a white sign with a black hand holding money (see explanations below).
http://www.autostrade.it/en/il-pedaggio/pagamento-al-casello

I don’t know where you are going, but unless you travel very long distances from the far north to the far south, you will rarely have to fork out more than 10€-20€ on each trip, or often even less.
For example from Florence to Bologna it’s only about 9€. From Florence to Rome or Florence to Venice or Florence to Milan only about 18-23€. Within Tuscany, the longest segment possible, from one end to the other of Tuscany (from Chiusi to La Spezia), will cost you 23€.