CT abdomen and pelvis with contrast at Davis County Hospital. CPT 74177.
What Davis County Hospital publishes for this service, straight from its standard-charges file, last updated July 24, 2026.
Outpatient / ER
$3,662cash price (self-pay)
$3,662list price
$375–$3,479range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Wellmark BCBS HMO | Wellmark BCBS HMO | $375 |
| Wellmark BCBS PPO - All Other Plans | Wellmark BCBS PPO - All Other Pl | $414 |
| Aetna Mcr Adv-All Plans | Aetna Mcr Adv-All Plans | $1,831 |
| Choicecare Mcr Adv | Choicecare Mcr Adv | $1,904 |
| Home State Hlth Exch - All Other Plans | Home State Hlth Exch - All Ot | $1,904 |
| Home State Hlth Mcr | Home State Hlth Mcr | $1,904 |
| Mt Carmel Hp-All Plans | Mt Carmel Hp-All Plans | $1,904 |
| Tricare-All Plans | Tricare-All Plans | $1,904 |
| Amerigroup Mcr Adv-All Other Plans | Amerigroup Mcr Adv-All Other Plan | $1,942 |
| American Hp Mcr Adv-All Plans | American Hp Mcr Adv-All Plans | $1,999 |
| Home State Hlth Mcaid | Home State Hlth Mcaid | $2,197 |
| Iowa Total Care Mcaid-All Plans | Iowa Total Care Mcaid-All Plans | $2,241 |
| Molina Mcaid-All Plans | Molina Mcaid-All Plans | $2,274 |
| Amerigroup Mcaid | Amerigroup Mcaid | $2,285 |
| Midlands Choice - All Plans | Midlands Choice - All Plans | $2,563 |
| Preferred Hlth Choices - All Plans | Preferred Hlth Choices - All Plan | $2,747 |
| Choicecare Comm - All Other Plans | Choicecare Comm - All Other Plans | $3,479 |
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