CT abdomen and pelvis with contrast at Advocate Good Samaritan Hospital. CPT 74177.
What Advocate Good Samaritan Hospital publishes for this service, straight from its standard-charges file, last updated November 4, 2025.
Outpatient / ER
$1,780cash price (self-pay)
$3,560list price
$540–$2,848range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Ambetter | Medicare Advantage | $540 |
| Molina | Medicare Advantage | $540 |
| Oscar Health HMO | Medicare Advantage | $558 |
| Cigna | Commercial | $653 |
| Cigna One Health | Commercial | $653 |
| HSTechnology | Medicare Advantage | $715 |
| United Healthcare | HMO | $718 |
| United Healthcare Charter | Commercial | $718 |
| United Healthcare Core Navigate | Commercial | $718 |
| United Healthcare Nexus | Commercial | $718 |
| Aetna | Commercial | $941 |
| Blue Cross Blue Shield City of Chicago | Commercial | $1,307 |
| Advocate Employee | Commercial | $1,403 |
| Blue Cross Blue Shield Choice | Commercial | $1,414 |
| Blue Cross Blue Shield | PPO | $1,488 |
| Blue Cross Blue Shield Blue Precision | Managed Care | $2,752 |
| Blue Cross Blue Shield | HMO | $2,805 |
| Multiplan | Commercial | $2,848 |
| Private Healthcare Systems | Commercial | $2,848 |
Inpatient
$1,780cash price (self-pay)
$3,560list price
$1,556–$2,848range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Advocate Employee | Commercial | $1,556 |
| Private Healthcare Systems | Commercial | $2,207 |
| Multiplan | Commercial | $2,848 |
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