CT head without contrast at Intermountain Health Good Samaritan Medical Center. CPT 70450.
What Intermountain Health Good Samaritan Medical Center publishes for this service, straight from its standard-charges file, last updated March 22, 2026.
Outpatient / ER
—cash price (self-pay)
$2,358list price
$106–$2,115range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kaiser Perm HMO | Kp Select HMO | $436 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $542 |
| Kaiser Perm HMO | Kaiser Out Of State | $542 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $542 |
| Aetna | Aetna Colorado Preferred | $556 |
| Allegiance | Cigna Sclhs Employees | $590 |
| Cigna Scl Employees | Cigna Sclhs Cdhp | $590 |
| Aetna | Aetna HMO/EPO | $599 |
| Aetna | Aetna Indemnity | $599 |
| Aetna | Aetna Other | $599 |
| Aetna | Aetna POS/Qpos | $599 |
| Aetna | Aetna PPO | $599 |
| Aetna | Aetna Src | $599 |
| Geha | Geha-Asa | $599 |
| Preferred One | Preferred One | $599 |
| Cigna | Cigna Co Public Option | $600 |
| Cigna | Cigna Connect Exchange | $600 |
| Cigna | Cigna Surefit | $600 |
| BCBS/Anthem | BCBS Co Federal | $912 |
| BCBS/Anthem | BCBS Co HMO | $912 |
| BCBS/Anthem | BCBS Co PPO | $912 |
| Choicecare Humana | Choicecare Humana HMO EPO | $990 |
| Choicecare Humana | Choicecare Humana PPO | $990 |
| Geha | Geha | $1,368 |
| Geha | Geha Mcr Supplemental | $1,368 |
| Cigna | Cigna HMO | $1,398 |
| Cigna | Cigna Indemnity | $1,398 |
| Cigna | Cigna Local Plus | $1,398 |
| Cigna | Cigna Other | $1,398 |
| Cigna | Cigna POS/Qpos | $1,398 |
Inpatient
—cash price (self-pay)
$2,358list price
$696–$2,358range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kaiser Perm HMO | Kp Select HMO | $696 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $993 |
| Kaiser Perm HMO | Kaiser Out Of State | $993 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $993 |
| Kaiser Self Funded | Kaiser Self Funded | $993 |
| Kaiser Perm PPO/POS | Kaiser Perm PPO/POS | $1,024 |
| Private Hlthcare Sys | Phcs Other | $1,769 |
| Private Hlthcare Sys | Phcs PPO | $1,769 |
| BCBS/Anthem | BCBS Co Indemnity | $1,985 |
| Multiplan Inc | Multiplan Inc Other | $2,004 |
| Multiplan Inc | Multiplan Inc PPO | $2,004 |
| Aetna | Aetna Nap | $2,115 |
| Cigna | Cigna HMO | $2,358 |
| Cigna | Cigna Indemnity | $2,358 |
| Cigna | Cigna Local Plus | $2,358 |
| Cigna | Cigna Other | $2,358 |
| Cigna | Cigna POS/Qpos | $2,358 |
| Cigna | Cigna PPO | $2,358 |
| Cigna | Eighth Dist Elect Ben Pln | $2,358 |
| Cigna | Health-Partners | $2,358 |
Billed more than this?
Scan my billSnap a photo of your bill. We compare every line with these prices and coding rules, free.
All common services at Intermountain Health Good Samaritan Medical Center