CT abdomen and pelvis with contrast at SBH Health System. CPT 74177.

What SBH Health System publishes for this service, straight from its standard-charges file, last updated February 27, 2026.

Outpatient / ER

$94.25cash price (self-pay)

$1,000list price

$66.15–$867range insurers pay

Insurance plan	Negotiated rate
MetroPlus Health \| CHP/HARP/HIV SNP/Medicaid	$180
MetroPlus Health \| Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliess	$180
SOMOS \| CHP/HARP/Medicaid	$193
SOMOS \| Essential	$193
Wellcare \| CHP/FHP/Medicaid	$206
Healthfirst \| CHP/FHP/Medicaid	$212
MetroPlus Health \| Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (No	$218
Aetna \| Gatekeeper/Non-Gatekeeper	$229
Aetna \| Government	$229
Fidelis \| Essential Plan Aliesa	$231
Fidelis \| CHP/HARP/Medicaid	$231
EmblemHealth \| Commercial	$231
United Healthcare \| Commercial	$240
Fidelis \| Essential Plan QHP	$244
Fidelis \| Qualified Health Plan	$244
Healthfirst \| Medicare Advantage	$244
Centers Plan For Healthy Living \| Dual Advantage/Medicare Advantage/Me	$257
Fidelis \| Medicare Advantage	$257
Healthfirst \| Commercial	$257
Healthfirst \| QHP	$257
MetroPlus Health \| Commercial/Exchange/Gold Care/Medicare Advantage	$257
Senior Whole Health \| Medicare Advantage	$257
VNS Choice \| FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Spec	$257
Hamaspik Choice Inc \| Medicare	$304
Hamaspik Choice Inc \| Medicaid	$304
Group Health Inc \| Medicare	$405
Healthfirst \| Essential Plan	$521
Cigna \| LocalPlus Benefit Plan	$540
Group Health Inc \| Commercial	$578
1199SEIU National Benefit Fund \| Commercial	$636

—cash price (self-pay)

$1,156list price

$578–$578range insurers pay

Insurance plan	Negotiated rate
Hamaspik Choice Inc \| Medicaid	$578

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