CT head without contrast at CHI Health Good Samaritan. CPT 70450.
What CHI Health Good Samaritan publishes for this service, straight from its standard-charges file, last updated February 28, 2026.
Outpatient / ER
$1,585cash price (self-pay)
$2,598list price
$86.61–$2,416range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Amerigroup | Medicaid|All Plans | $86.61 |
| Centene | Medicaid|IA Total Care | $86.61 |
| IAMolina | Medicaid|All Plans | $88.31 |
| BCBS - NE | Medicare|All Plans | $101 |
| Humana | Medicare|All Plans | $101 |
| Medica | Medicare|All Plans | $101 |
| PACE | Medicare|All Plans | $101 |
| United | Medicare|All Plans | $101 |
| Centene | Medicare|All Plans | $104 |
| Amerigroup | Medicare|All Plans | $106 |
| Great Plains | Medicare|All Plans | $106 |
| Medica | Commercial|ACO | $130 |
| Medica | Commercial|CHI Health | $212 |
| Medica | Commercial|All Other Plans | $222 |
| AMPS | Commercial|All Plans | $224 |
| Greater Omaha Packing | Commercial|Narrow Network | $489 |
| Millard Public Schools | Commercial|Narrow Network | $489 |
| One World | Commercial|Narrow Network | $489 |
| United | Medicaid|Community Plan | $546 |
| Centene | Medicaid|NE Total Care | $551 |
| Greater Omaha Packing | Commercial|Broad Network | $562 |
| Millard Public Schools | Commercial|Broad Network | $562 |
| One World | Commercial|Broad Network | $562 |
| Timpte | Commercial|Broad Network | $562 |
| Creighton University Employees | Commercial|All Plans | $1,273 |
| ELAP | Commercial|All Plans | $1,507 |
| United | Commercial|All Plans | $1,974 |
| Medica | Commercial|Open Access | $2,026 |
| Midlands Choice | Commercial|Premier | $2,026 |
| Midlands Choice | Commercial|Standard | $2,390 |
Inpatient
$1,585cash price (self-pay)
$2,598list price
$1,273–$2,416range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Creighton University Employees | Commercial|All Plans | $1,273 |
| United | Commercial|All Plans | $1,974 |
| Medica | Commercial|Open Access | $2,026 |
| Midlands Choice | Commercial|Premier | $2,026 |
| Midlands Choice | Commercial|Standard | $2,390 |
| MultiPlan PHCS | Commercial|All Plans | $2,416 |
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