CT abdomen and pelvis with contrast at Samaritan Hospital. CPT 74177.
What Samaritan Hospital publishes for this service, straight from its standard-charges file, last updated March 31, 2026.
Outpatient / ER
$188cash price (self-pay)
$188list price
$54.95–$4,322range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Mvp Medicaid Advantage | Mvp Medicaid | $65.41 |
| Fidelis Care Medicaid Advantage | Fidelis Medicaid Epp 1 & 2 Qhp | $147 |
| Fidelis Care Medicaid Advantage | Fidelis Medicaid Ess Plan 3 &4 | $147 |
| Mvp Medicaid Advantage | Mvp Medicaid Essential 1 2 3 4 | $147 |
| Capital District Physicians Health Medicaid Advantage | Cdphp Medicaid | $245 |
| Blue Cross - NY (Excellus) Medicaid Advantage | Empire Medicaid Essent | $245 |
| Capital District Physicians Health Plan | Cdphp | $330 |
| Eddy Seniorcare Pace | Eddy Senior Care | $435 |
| Hudson Headwaters Pace | Hudson Headwaters Pace | $470 |
| Emblem Health Medicare Advantage | Emblem Medicare Advantage | $487 |
| Nascentia Health Plus | Nascentia Health Plus Medicare Advantage | $488 |
| Blue Shield - NY Highmark Northeastern | Blue Shield Of Ne New York As | $636 |
| Blue Cross - Pa (Independence) | Blue Shield Of Ne New York HMO | $821 |
| Blue Shield - NY Highmark Northeastern | Blue Shield Of Ne New York Hm | $821 |
| Blue Cross - Wy | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - Sc | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - Wv (Highmark) | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Shield - Wa (Regence) | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - Wa (Premera) | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - Va (Carefirst) | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - Vt | Blue Shield Of Ne New York PPO | $1,027 |
| BCBS Generic | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - Ri | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Shield - Pa (Highmark) | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - Pa (Capital) | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - NY (Excellus) | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - Az | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - Al | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - Nm | Blue Shield Of Ne New York PPO | $1,027 |
| Blue Cross - Ak (Premera) | Blue Shield Of Ne New York PPO | $1,027 |
Inpatient
$225cash price (self-pay)
$225list price
$54.95–$385range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Pace Of Southwest Michigan | Pb Xr 100% Default | $225 |
| Commonwealth Care Alliance | Pb Xr 100% Default | $225 |
| Everence | Pb Xr 100% Default | $225 |
| Dentaquest | Pb Xr 100% Default | $225 |
| Health Choices | Pb Xr 100% Default | $225 |
| Rx Allwin | Pb Xr 100% Default | $225 |
| Harvard Pilgrim Healthcare | Pb Xr 100% Default | $225 |
| Molina Medicare Advantage | Pb Xr 100% Default | $225 |
| Union Health Service | Pb Xr 100% Default | $225 |
| The Health Plan | Pb Xr 100% Default | $225 |
| Medicaid - Ut | Pb Xr 100% Default | $225 |
| Medicaid - TX | Pb Xr 100% Default | $225 |
| Magellan Behavioral Health Medicaid | Pb Xr 100% Default | $225 |
| Huron Valley Pace Medicaid | Pb Xr 100% Default | $225 |
| Community Care Plan Medicaid Advantage | Pb Xr 100% Default | $225 |
| Rx Ihc | Pb Xr 100% Default | $225 |
| Rx Medtrak | Pb Xr 100% Default | $225 |
| Rx Promark | Pb Xr 100% Default | $225 |
| Rx Ldi | Pb Xr 100% Default | $225 |
| Rx Patient Support Program | Pb Xr 100% Default | $225 |
| Rx Dispensary Of Hope | Pb Xr 100% Default | $225 |
| Wellpoint Maryland | Pb Xr 100% Default | $225 |
| Asi - Navia Benefit Solutions | Pb Xr 100% Default | $225 |
| Curative | Pb Xr 100% Default | $225 |
| Brms | Pb Xr 100% Default | $225 |
| National Marrow Donor Program | Pb Xr 100% Default | $225 |
| Auto Progressive | Pb Xr 100% Default | $225 |
| Wc Aig | Pb Xr 100% Default | $225 |
| Upmc Medicare Advantage | Pb Xr 100% Default | $225 |
| Blue Cross - Ne Medicare Advantage | Pb Xr 100% Default | $225 |
Billed more than this?
Scan my billSnap a photo of your bill. We compare every line with these prices and coding rules, free.