CT head without contrast at Jones Memorial Hospital. CPT 70450.
What Jones Memorial Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$202cash price (self-pay)
$405list price
$72.72–$534range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Amerigroup (Blue Cross Blue Shield Wny Alternate) 1720 | Amerigroup (B | $96.96 |
| Fidelis 5155 | Fidelis Metal Tiers 515501 | $96.96 |
| Fidelis Medicaid 1708 | Fidelis Medicaid 170801, Fidelis Child Health | $96.96 |
| Highmark Blue Cross Blue Shield Medicaid 5143 | Highmark BCBS Essentia | $96.96 |
| Independent Health Assoc Medicaid 1710 | Independent Health Medicaid 1 | $96.96 |
| United Healthcare Medicaid 1716 | United Healthcare Medicaid 171601, U | $96.96 |
| United Healthcare Medicaid 5158 | United Healthcare Essential 1-2 200- | $96.96 |
| Univera Healthcare 1706 | Univera Medicaid 170607, Univera Essential 3 | $96.96 |
| Upmc Health Plan 5138 | Upmc Health Plan 513801 | $105 |
| Mvp Medicaid 1712 | Mvp Option Medicaid 171201, Mvp Child Health Plus | $116 |
| Molina Healthcare 1723 | Molina Medicaid 172301, Molina Child Health | $133 |
| Excellus Blue Cross Blue Shield 2201, Out Area Blue Cross Blue Shield, | $140 |
| Fidelis Medicare 1311 | Fidelis Medicare 131101 | $140 |
| Humana Medicare 1312 | Humana Medicare 131201 | $140 |
| Medicare Blue Choice 1306 | Medicare Blue Choice 130601 | $140 |
| United Healthcare Medicare 1309 | United Healthcare Medicare 130901 | $140 |
| Wellcare Medicare 1310 | Wellcare Medicare 131001 | $140 |
| Highmark Blue Cross Blue Shield Medicare 1301 | Highmark BCBS Medicare | $140 |
| Total Senior Care 1319 | Total Senior Care 131901 | $140 |
| Aetna Medicare 1300 | Aetna Medicare 130001 | $148 |
| Cdphp Medicare 1320 | Cdphp Medicare 132001 | $151 |
| Mvp Medicare 1307 | Mvp Medicare 130701 | $154 |
| Mvp Medicaid 1712 | Mvp Essential 3-4 171204, Mvp Essential 1-2 200-25 | $199 |
| Independent Health 5156 | Independent Health (Buffalo NY) 515601 | $203 |
| Independent Health Medicare 1305 | Independent Health Medicare 130501 | $203 |
| Highmark Blue Cross Blue Shield Medicaid 1702 | Highmark BCBS Medicaid | $210 |
| Fidelis Medicaid 1708 | Fidelis Essential 3-4 170804, Fidelis Essentia | $218 |
| Highmark Blue Cross Blue Shield 5143 | Highmark BCBS 514301 HMO / POS | $224 |
| Empire Plan 5179 | Empire Plan 517901 | $247 |
| Molina Healthcare 1723 | Molina Essential 3-4 172302, Molina Essential | $273 |
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