CT abdomen and pelvis with contrast at Good Samaritan Hospital. CPT 74177.
What Good Samaritan Hospital publishes for this service, straight from its standard-charges file, last updated September 1, 2026.
Outpatient / ER
$44,564cash price (self-pay)
$44,564list price
$203–$44,564range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Physicians Medical Group | MCD | $203 |
| Santa Clara Family Health Plan | Medicaid | $210 |
| Anthem | Medi-Cal | $223 |
| Physician Health Network | MGMCD | $223 |
| United | AllPayerAppendix | $828 |
| Anthem | ExchangeEPO | $1,146 |
| Anthem | BlueConnection | $1,208 |
| Anthem | COMM | $1,208 |
| Blue Shield | COMM | $3,077 |
| Blue Shield | EPN | $3,077 |
| Aetna | AWH | $4,973 |
| Aetna | HMO | $5,074 |
| Aetna | PPO | $5,074 |
| MedCare Partners | MGMCR | $6,685 |
| United | OptionsPPO | $11,364 |
| United | GlobalBenefitPlan | $20,054 |
| NX Health Network | COMM | $26,739 |
| Sutter Select | COMM | $26,739 |
| MultiPlan | Primary | $28,967 |
| ChoiceCare Humana | COMM | $31,195 |
| First Health | COMM | $33,869 |
| Cigna BH | COMMBH | $35,651 |
| HealthSmart | WCOMP | $35,651 |
| Intercontinental Corporation | COMM | $35,651 |
| MultiPlan | Complementary | $35,651 |
| PHA Pacific Health Alliance | COMM | $35,651 |
| PPO Next | COMM | $35,651 |
| PPO Next | PPO | $35,651 |
| HealthSmart | COMM | $37,880 |
| First Health | WCOMP | $44,564 |
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