CT abdomen and pelvis with contrast at Northern Light Sebasticook Valley Hospital. CPT 74177.
What Northern Light Sebasticook Valley Hospital publishes for this service, straight from its standard-charges file, last updated March 30, 2026.
Outpatient / ER
$105cash price (self-pay)
$2,420list price
$80.46–$4,530range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna | MCR Advantage | $117 |
| Anthem | MCR Advantage | $117 |
| Martin's Point | MCR Advantage | $117 |
| UHC | MCR Advantage | $117 |
| Wellcare | MCR Advantage | $117 |
| UHC | Commercial | $293 |
| CHO | Commercial | $341 |
| Aetna | Commercial | $341 |
| Harvard | Commercial | $357 |
| Anthem | Commercial | $415 |
| Anthem | Enhanced Pathways | $415 |
| Cigna | Commercial | $529 |
Inpatient
$105cash price (self-pay)
$2,420list price
$201–$4,530range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem | Commercial | $1,573 |
| Anthem | Enhanced Pathways | $1,573 |
| UHC | Commercial | $1,754 |
| Cigna | Commercial | $1,805 |
| Aetna | Commercial | $1,815 |
| CHO | Commercial | $2,420 |
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All common services at Northern Light Sebasticook Valley Hospital