CT abdomen and pelvis with contrast at Legacy Good Samaritan Medical Center IP Rehab. CPT 74177.
What Legacy Good Samaritan Medical Center IP Rehab publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$157cash price (self-pay)
$739list price
$386–$1,578range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna | All Commercial Plans | $386 |
| Kaiser | Medicare Managed Care Plan | $388 |
| Atrio | Medicare Managed Care Plan | $399 |
| Aetna | Medicare Managed Care Plan | $407 |
| HealthNet | Medicare Managed Care Plan | $411 |
| CareOregon | Medicare Managed Care Plan | $419 |
| Ageright | Medicare Managed Care Plan | $427 |
| Moda | Medicare Managed Care Plan | $434 |
| PacificSource | Navigator All Commercial Plans | $481 |
| Kaiser | PEBB Other Commercial Plan | $776 |
| Cigna | All Commercial Plans | $1,027 |
| Cigna | LocalPlus All Commercial Plans | $1,027 |
| BCBS | Regence - Legacy LHP All Commercial Plans | $1,076 |
| PacificSource | Voyager All Commercial Plans | $1,099 |
| HealthNet | All Commercial Plans | $1,315 |
| Moda | All Commercial Plans | $1,500 |
| BCBS | Regence - Blue HPN All Commercial Plans | $1,507 |
| BCBS | Regence All Commercial Plans | $1,578 |
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All common services at Legacy Good Samaritan Medical Center IP Rehab