CT head without contrast at Good Samaritan Hospital. CPT 70450.
What Good Samaritan Hospital publishes for this service, straight from its standard-charges file, last updated June 29, 2026.
Outpatient / ER
$2,089cash price (self-pay)
$2,089list price
$130–$6,653range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Beacon Medicare | Beacon Medicare | $130 |
| Hamaspik (Mcr) | Hamaspik (Mcr) | $130 |
| Medicare Managed | Medicare Managed | $130 |
| Mvp Gold (Mcr) | Mvp Gold (Mcr) | $130 |
| Tricare | Tricare | $131 |
| Medicare | Medicare | $131 |
| Emblem Ghi/Hip Medicare | Emblem Ghi/Hip Medicare | $132 |
| Affinity By Molina Mcr | Affinity By Molina Mcr | $136 |
| Health First Medicare | Health First Medicare | $139 |
| Beacon Exchange | Beacon Exchange | $156 |
| Beacon Commercial | Beacon Commercial | $169 |
| Emblem Select Care (Exchange) | Emblem Select Care (Exchange) | $226 |
| Aetna HP Network | Aetna HP Network | $227 |
| Aetna Employee | Aetna Employee | $232 |
| Aetna | Aetna | $252 |
| Emblem Ghi/Hip PPO | Emblem Ghi/Hip PPO | $266 |
| Cigna PPO | Cigna PPO | $269 |
| Mvp Exchange | Mvp Exchange | $287 |
| Geisinger Health Commercial/Exchange | Geisinger Health Commercial/Exc | $429 |
| Mvp HMO/PPO | Mvp HMO/PPO | $558 |
| SELF-PAY - CC 30% | SELF-PAY - CC 30 PerCent | $627 |
| Cdphp | Cdphp | $1,045 |
| Self-Pay - Cc 50% | Self-Pay - Cc 50 | $1,045 |
| Blue Cross Connection/Exchange | Blue Cross Connection/Exchange | $1,078 |
| Self-Pay | Self-Pay | $1,192 |
| Blue Cross Small Group | Blue Cross Small Group | $1,294 |
| Blue Cross HMO | Blue Cross HMO | $1,330 |
| Magnacare Standard | Magnacare Standard | $1,462 |
| Multiplan | Multiplan | $1,567 |
| Phcs | Phcs | $1,567 |
Inpatient
$2,089cash price (self-pay)
$2,089list price
$627–$1,462range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| SELF-PAY - CC 30% | SELF-PAY - CC 30 PerCent | $627 |
| Cdphp | Cdphp | $1,045 |
| Self-Pay - Cc 50% | Self-Pay - Cc 50 | $1,045 |
| Magnacare Standard | Magnacare Standard | $1,462 |
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