CT abdomen and pelvis with contrast at Banner Goldfield Medical Center. CPT 74177.
What Banner Goldfield Medical Center publishes for this service, straight from its standard-charges file, last updated September 23, 2026.
Outpatient / ER
$645cash price (self-pay)
$3,642list price
$242–$2,732range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Arizona Physicians IPA | Medicaid | $242 |
| Banner University Health Plan | AZ Medicaid - AHCCCS | $242 |
| Health Choice Arizona, Inc. | Medicaid | $242 |
| Health Net | Medicaid | $242 |
| Mercy Care | Mercy Medicaid | $242 |
| Aetna | Banner Employee Plans | $358 |
| Banner Health | Medicare Advantage | $372 |
| Arizona Physicians IPA | Medicare Advantage | $372 |
| Banner University Health Plan | University Care Advantage | $372 |
| Blue Cross Blue Shield of Arizona | Medicare Advantage | $372 |
| Cigna Healthcare of Arizona, Inc. | HMO Medicare Advantage Plans | $372 |
| Cigna Healthcare of Arizona, Inc. | PPO Medicare Advantage Plan | $372 |
| Carekin | Medicare Advantage | $391 |
| Aetna | Medicare Advantage | $525 |
| Health Choice Arizona, Inc. | Medicare Advantage | $732 |
| Blue Cross Blue Shield of Arizona | BXBSAZ Neighborhood | $797 |
| United Healthcare | Commercial | $804 |
| United Healthcare | UHC Core | $805 |
| Aetna | Joint Venture | $817 |
| Blue Cross Blue Shield of Arizona | BCBSAZ Alliance/Blue HPN | $850 |
| Aetna | Designated Group | $868 |
| Blue Cross Blue Shield of Arizona | BXBSAZ Alliance CHS | $892 |
| Arizona Priority Care | Medicare Advantage | $933 |
| Aetna | Broad Network | $1,021 |
| Blue Cross Blue Shield of Arizona | BCBSAZ Workers Comp | $1,062 |
| Blue Cross Blue Shield of Arizona | Commercial | $1,062 |
| Blue Cross Blue Shield of Arizona | Medicare Supplemental Senior Prefe | $1,082 |
| Cigna Healthcare of Arizona, Inc. | LocalFlex | $1,096 |
| Health Net | Medicare | $1,097 |
| Health Choice Arizona, Inc. | ACA Health Plan | $1,190 |
Inpatient
$645cash price (self-pay)
$3,642list price
$1,639–$2,732range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| National Healthcare Solutions Inc (NHSI) and VIP Universal Medical Ins | $1,639 |
| Plotkin Health | Plotkin Health | $1,639 |
| Aetna | Medical Rental | $1,868 |
| Quiktrip Corporation | Commercial | $1,948 |
| Provider Network of America | Commercial | $2,732 |
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