CT abdomen and pelvis with contrast at Holy Cross Hospital - Jordan Valley. CPT 74177.
What Holy Cross Hospital - Jordan Valley publishes for this service, straight from its standard-charges file, last updated February 11, 2026.
Outpatient / ER
$2,724cash price (self-pay)
$6,809list price
$170–$6,809range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| UUHP | Managed Medicaid | $170 |
| Rocky Mountain Health Plan | Managed Medicaid | $170 |
| Molina | Managed Medicaid | $170 |
| Health Choice | Managed Medicaid | $170 |
| Aetna | Managed Medicaid | $170 |
| Medicare | Medicare | $195 |
| Medicare | Managed Medicare | $195 |
| Humana | Managed Medicare | $195 |
| Cigna Healthcare | Commercial Local Plus | $243 |
| Employer Direct Healthcare | Commercial PPO/POS/HMO | $245 |
| MotivHealth | Commercial PPO/POS/HMO | $259 |
| Cigna Healthcare | Commercial HMO/NBP/OAP | $298 |
| Centura Employee Plan | Commercial PPO/POS/HMO/EPO | $337 |
| Regence Blue Cross Blue Shield | Commercial UVU | $366 |
| Regence Blue Cross Blue Shield | Commercial Savewell | $366 |
| Regence Blue Cross Blue Shield | Commercial PPO | $366 |
| Regence Blue Cross Blue Shield | Commercial PAR | $366 |
| Molina | Commercial PPO/POS/HMO | $459 |
| United Healthcare | Commercial PPO/POS/HMO | $480 |
| Cigna Healthcare | Commercial All Other | $505 |
| UUHP | Commercial Health Plus | $1,169 |
| UUHP | Commercial Healthy Preferred | $1,257 |
| UUHP | Commercial Healthy Premier | $1,397 |
| PEHP | Commercial Summit Exclusive | $1,554 |
| PEHP | Commercial Capital Network | $2,908 |
| Aetna | Commercial Peak Performance | $3,008 |
| PEHP | Commercial Summit | $3,466 |
| Wise | Commercial PPO | $3,541 |
| Aetna | Commercial Standard Network | $3,589 |
| Deseret Mutual Benefit Administrators | Commercial PPO/POS/HMO | $4,181 |
Inpatient
$2,724cash price (self-pay)
$6,809list price
$2,532–$6,809range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Regence Blue Cross Blue Shield | Commercial Savewell | $2,532 |
| PEHP | Commercial Capital Network | $2,908 |
| Molina | Commercial PPO/POS/HMO | $2,924 |
| Aetna | Commercial Peak Performance | $3,008 |
| Regence Blue Cross Blue Shield | Commercial UVU | $3,120 |
| PEHP | Commercial Summit Exclusive | $3,221 |
| PEHP | Commercial Summit | $3,466 |
| Aetna | Commercial Standard Network | $3,589 |
| Wise | Commercial PPO | $3,609 |
| Regence Blue Cross Blue Shield | Commercial PPO | $3,670 |
| Regence Blue Cross Blue Shield | Commercial PAR | $4,086 |
| Deseret Mutual Benefit Administrators | Commercial PPO/POS/HMO | $4,181 |
| Select Health | Commercial PPO/POS/HMO | $4,506 |
| Multiplan | Commercial Primary | $4,699 |
| Aetna | Commercial Signature | $4,949 |
| Aetna | Commercial Extended Network | $5,107 |
| Aetna | Commercial Indemnity | $5,448 |
| Aetna Rental Networks | Commercial PPO/POS/HMO | $5,754 |
| Multiplan | Commercial Complementary | $6,197 |
| PEHP | Commercial Advantage | $6,809 |
| EMI Health | Commercial PPO/POS/HMO | $6,809 |
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