CT abdomen and pelvis with contrast at Samaritan Medical Center. CPT 74177.
What Samaritan Medical Center publishes for this service, straight from its standard-charges file, last updated February 2, 2026.
Outpatient / ER
$3,548cash price (self-pay)
$3,548list price
$77.61–$3,015range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Empire | Commercial | $195 |
| Fidelis | Medicaid Managed Care/Child Health Plus and Family Health Pl | $205 |
| Fidelis | Essential Plan Program/Aliessa and Essential Plan Program-QH | $226 |
| Fidelis | Medicare Advantage/Managed Long Term Care | $246 |
| Wellcare | Medicare Advantage | $246 |
| Fidelis | Health Benefit Exchange | $271 |
| Capital District Physician's Health Plan, Inc (CDPHP) | Medicare Advan | $435 |
| Excellus | Medicare Advantage | $435 |
| Aetna | Medicare Advantage | $444 |
| United Healthcare | Medicare Advantage | $449 |
| MVP | Medicare Advantage | $457 |
| Capital District Physician's Health Plan, Inc (CDPHP) | Commercial | $660 |
| Excellus | Commercial | $1,229 |
| MVP | Individual Commercial (HMO, EPO/PPO) Plans | $2,320 |
| MVP | Student Health Plans | $2,320 |
| MVP | Small/Large Group Commercial (HMO, EPO/PPO, ASO) Plans | $2,696 |
| UMR | Commercial | $2,767 |
| GHI Emblem | Commercial | $2,944 |
| Aetna | Commercial | $3,015 |
| United Healthcare | Commercial | $3,015 |
Inpatient
$3,548cash price (self-pay)
$3,548list price
$2,838–$2,838range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Capital District Physician's Health Plan, Inc (CDPHP) | Commercial | $2,838 |
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