CT head without contrast at Samaritan Hospital. CPT 70450.
What Samaritan Hospital publishes for this service, straight from its standard-charges file, last updated March 31, 2026.
Outpatient / ER
$88.00cash price (self-pay)
$88.00list price
$25.56–$3,256range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Mvp Medicaid Advantage | Mvp Medicaid | $72.72 |
| Fidelis Care Medicaid Advantage | Fidelis Medicaid Mmc Harp Chp Mltc | $124 |
| Blue Cross - NY (Anthem) Medicare Advantage | Empire BCBS Medicare Adv | $128 |
| Medigold Medicare Advantage | Medigold Medicare Advantage | $130 |
| Eddy Seniorcare Pace | Eddy Senior Care | $131 |
| Capital District Physicians Health Plan Medicare Advantage | Cdphp Med | $131 |
| Mvp Medicare Advantage | Mvp Medicare Advantage | $131 |
| Aetna Medicare Advantage | Aetna Medicare Advantage | $138 |
| Hudson Headwaters Pace | Hudson Headwaters Pace | $141 |
| Fidelis Medicare | Fidelis Medicare Advantage | $143 |
| Wellcare Medicare | Wellcare Medicare Advantage | $143 |
| Blue Shield - NY Highmark Northeastern Medicare Advantage | Blue Shiel | $144 |
| Blue Cross - NY (Excellus) Medicare Advantage | Blue Shield Of Ne New | $144 |
| Emblem Health Medicare Advantage | Emblem Medicare Advantage | $146 |
| Nascentia Health Plus | Nascentia Health Plus Medicare Advantage | $146 |
| United Healthcare Medicaid | United Healthcare Medicaid Harp Chip | $155 |
| Fidelis Care Medicaid Advantage | Fidelis Medicaid Epp 1 & 2 Qhp | $164 |
| Fidelis Care Medicaid Advantage | Fidelis Medicaid Ess Plan 3 &4 | $164 |
| Mvp Medicaid Advantage | Mvp Medicaid Essential 1 2 3 4 | $164 |
| Capital District Physicians Health Plan | Cdphp | $189 |
| Nascentia Health Options | Vna Homecare Options | $189 |
| Blue Cross - NY (Excellus) Medicaid Advantage | Empire Medicaid | $200 |
| Capital District Physicians Health Medicaid Advantage | Cdphp Medicaid | $273 |
| Blue Cross - NY (Excellus) Medicaid Advantage | Empire Medicaid Essent | $425 |
| Blue Cross - Nj (Horizon) | Blue Shield Of Ne New York HMO | $438 |
| Blue Cross - Ia (Wellmark) | Blue Shield Of Ne New York HMO | $438 |
| United Healthcare Medicaid | UHC Essential Plan Medicaid | $528 |
| Blue Cross - Al | Blue Shield Of Ne New York PPO | $548 |
| Blue Cross - Nm | Blue Shield Of Ne New York PPO | $548 |
| Blue Cross - Ak (Premera) | Blue Shield Of Ne New York PPO | $548 |
Inpatient
$105cash price (self-pay)
$105list price
$25.56–$302range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Champva | Tricare | $36.44 |
| Tricare | Tricare | $36.44 |
| Us Family Health Plan | Martins Point Us Health Care | $37.96 |
| Health Choices | Pb Xr 100% Default | $105 |
| Pace Of Southwest Michigan | Pb Xr 100% Default | $105 |
| Dentaquest | Pb Xr 100% Default | $105 |
| Commonwealth Care Alliance | Pb Xr 100% Default | $105 |
| Union Health Service | Pb Xr 100% Default | $105 |
| Everence | Pb Xr 100% Default | $105 |
| Harvard Pilgrim Healthcare | Pb Xr 100% Default | $105 |
| The Health Plan | Pb Xr 100% Default | $105 |
| Rx Allwin | Pb Xr 100% Default | $105 |
| Molina Medicare Advantage | Pb Xr 100% Default | $105 |
| Mpn | Pb Xr 100% Default | $105 |
| Multiplan | Pb Xr 100% Default | $105 |
| North American Administrators | Pb Xr 100% Default | $105 |
| Navigere | Pb Xr 100% Default | $105 |
| Carisk | Pb Xr 100% Default | $105 |
| Nys Dept Of Civil Services | Pb Xr 100% Default | $105 |
| Forethought Life Insurance Company | Pb Xr 100% Default | $105 |
| Orchid Medical | Pb Xr 100% Default | $105 |
| Rx Rx America | Pb Xr 100% Default | $105 |
| Rx Hds | Pb Xr 100% Default | $105 |
| Rx Bridges Access | Pb Xr 100% Default | $105 |
| Rx Data Rx Egentra | Pb Xr 100% Default | $105 |
| Aetna Medicare Assure Premier HMO D-Snp | Pb Xr 100% Default | $105 |
| Anthem Mycare Ohio | Pb Xr 100% Default | $105 |
| Bureau Of Disability | Pb Xr 100% Default | $105 |
| Careworks | Pb Xr 100% Default | $105 |
| Indian Health Services | Pb Xr 100% Default | $105 |
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