CT abdomen and pelvis with contrast at Sullivan County Community Hospital. CPT 74177.
What Sullivan County Community Hospital publishes for this service, straight from its standard-charges file, last updated June 10, 2026.
Outpatient / ER
$4,081cash price (self-pay)
$5,442list price
$162–$4,626range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Humana Mcaid | Humana Mcaid | $162 |
| Mdwise Mcaid - All Other Plans | Mdwise Mcaid - All Other Plans | $162 |
| Mhs Mcaid - All Other Plans | Mhs Mcaid - All Other Plans | $162 |
| Mhs Hlthy In Mcaid | Mhs Hlthy In Mcaid | $356 |
| Ambetter Comm-Exch - All Plans | Ambetter Comm-Exch - All Plans | $1,633 |
| BCBS Mcr Adv | BCBS Mcr Adv | $1,633 |
| Mdwise Mcr Adv | Mdwise Mcr Adv | $1,633 |
| Va Ccn - All Plans | Va Ccn - All Plans | $1,633 |
| BCBS Essential | BCBS Essential | $1,633 |
| Humana Mcr Adv | Humana Mcr Adv | $1,649 |
| BCBS Pathway X | BCBS Pathway X | $1,940 |
| BCBS Healthsync | BCBS Healthsync | $1,940 |
| BCBS HMO | BCBS HMO | $2,393 |
| BCBS PPO | BCBS PPO | $2,424 |
| BCBS Pathway | BCBS Pathway | $2,424 |
| BCBS Trad - All Other Plans | BCBS Trad - All Other Plans | $2,871 |
| Siho - All Plans | Siho - All Plans | $4,081 |
| Humana Comm - All Other Plans | Humana Comm - All Other Plans | $4,626 |
| UHC All Payer - All Plans | UHC All Payer - All Plans | $4,626 |
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