CT abdomen and pelvis with contrast at SSM Health Good Samaritan Hospital - Mt. Vernon. CPT 74177.
What SSM Health Good Samaritan Hospital - Mt. Vernon publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$4,334cash price (self-pay)
$7,880list price
$374–$393range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Molina | Dual Eligible Medicare/Medicaid | $374 |
| UnitedHealthCare | Medicare Managed Care Plan | $389 |
| Essence Healthcare | Medicare Managed Care Plan | $393 |
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All common services at SSM Health Good Samaritan Hospital - Mt. Vernon