Providence St Mary Medical Center — CT scan prices
← Hospital overviewVerified from Providence St Mary Medical Center’s published price file
Includes cash prices, list prices. Open any row for plan-level negotiated rates. This is public hospital price transparency data, not a guaranteed estimate of your bill.
How to read these columns
- List
- The hospital’s full undiscounted (gross) charge — rarely what anyone actually pays.
- Cash
- The discounted self-pay price for paying directly, without insurance.
- Negotiated
- Rates agreed with insurers; open a row for plan-level detail. Your share depends on your benefits.
These are the hospital’s published reference prices, not a personalized estimate of your bill.
16 prices shown.
| Service | Code | List price | Cash price | Negotiated range | Allowed (median) | |
|---|---|---|---|---|---|---|
| HC CT ABD & PELVIS WO CONTRAST Inpatient & outpatient | 74176 HCPCS | $3,991 | $2,794 | — | — | |
| HC CT ABD & PELVIS WO CONTRAST Outpatient | 74176 HCPCS | $3,192 | $2,234 | — | — | |
| HC CT ABDOMEN & PELVIS W CONTRAST Inpatient & outpatient | 74177 HCPCS | $5,104 | $3,573 | — | — | |
| HC CT ABDOMEN & PELVIS W CONTRAST Outpatient | 74177 HCPCS | $4,083 | $2,858 | — | — | |
| HC CT ABDOMEN & PELVIS W & W/O CONTRAST Inpatient & outpatient | 74178 HCPCS | $6,150 | $4,305 | — | — | |
| HC CT ABDOMEN & PELVIS W & W/O CONTRAST Outpatient | 74178 HCPCS | $4,921 | $3,445 | — | — | |
| HC CT HEAD/BRAIN W CONTRAST Inpatient & outpatient | 70460 HCPCS | $2,044 | $1,431 | — | — | |
| HC CT HEAD/BRAIN W CONTRAST Outpatient | 70460 HCPCS | $1,636 | $1,145 | — | — | |
| HC CT HEAD/BRAIN WO CONTRAST Inpatient & outpatient | 70450 HCPCS | $1,728 | $1,210 | — | — | |
| HC CT HEAD/BRAIN WO CONTRAST Outpatient | 70450 HCPCS | $1,383 | $968 | — | — | |
| HC CT THORAX W CONTRAST Inpatient & outpatient | 71260 HCPCS | $2,593 | $1,815 | — | — | |
| HC CT THORAX W CONTRAST Outpatient | 71260 HCPCS | $2,074 | $1,452 | — | — | |
| HC CT THORAX W/O DYE F/U LUNG SCREENING Inpatient & outpatient | 71250 HCPCS | $2,038 | $1,427 | — | — | |
| HC CT THORAX W/O DYE F/U LUNG SCREENING Outpatient | 71250 HCPCS | $852 | $596 | — | — | |
| HC CT THORAX WO CONTRAST Inpatient & outpatient | 71250 HCPCS | $2,038 | $1,427 | — | — | |
| HC CT THORAX WO CONTRAST Outpatient | 71250 HCPCS | $1,630 | $1,141 | — | — |