CT abdomen and pelvis with contrast at IHC Health Services Inc., DBA Intermountain Primary Children's Hospital. CPT 74177.
What IHC Health Services Inc., DBA Intermountain Primary Children's Hospital publishes for this service, straight from its standard-charges file, last updated August 5, 2026.
Outpatient / ER
$1,767cash price (self-pay)
$2,356list price
$85.32–$2,073range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Health Plan of Nevada | Medicaid | $174 |
| Healthy U | Medicaid | $204 |
| Molina | Medicaid | $204 |
| SelectHealth | Medicaid | $211 |
| American Health | Medicare Adv UT HMO I-SNP | $212 |
| Molina | Medicare Advantage | $218 |
| Molina | Medicare Choice Care HMO | $218 |
| Molina | Medicare Complete Care HMO SNP | $218 |
| Southwest Behavioral Health | Behavioral Health | $218 |
| UHC | Medicare Advantage | $218 |
| Donor Connect | Other | $938 |
| Aetna | Standard | $1,979 |
| BYU Athletics | Commercial | $1,979 |
| Campbell Scientific | Commercial | $1,979 |
| Cigna | HMO | $1,979 |
| Cigna | Open Access Flex | $1,979 |
| Cigna | PPO/EPO | $1,979 |
| Cigna | Utah Connect/Local Plus | $1,979 |
| Deseret Mutual | All Other | $1,979 |
| EMI Health | Mint | $1,979 |
| EMI Health | Network Care | $1,979 |
| EMI | Commercial | $1,979 |
| First Choice of the Midwest | Commercial | $1,979 |
| First Choice | Commercial | $1,979 |
| Franklin County | Commercial | $1,979 |
| Global Excel | Commercial | $1,979 |
| Health Utah | Commercial | $1,979 |
| Humana | Commercial | $1,979 |
| Hygeia Corporation | Commercial | $1,979 |
| Juniper Systems | Commercial | $1,979 |
Inpatient
$1,767cash price (self-pay)
$2,356list price
$848–$2,073range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Donor Connect | Other | $848 |
| American Health | Medicare Adv UT HMO I-SNP | $1,343 |
| Molina | Medicare Advantage | $1,414 |
| Molina | Medicare Choice Care HMO | $1,414 |
| Molina | Medicare Complete Care HMO SNP | $1,414 |
| AWH Connected | Connected Utah | $1,673 |
| Aetna | Connected | $1,673 |
| Aetna | Extended | $1,673 |
| Aetna | Standard | $1,673 |
| BYU Athletics | Commercial | $1,673 |
| Campbell Scientific | Commercial | $1,673 |
| Cigna | HMO | $1,673 |
| Cigna | Open Access Flex | $1,673 |
| Cigna | PPO/EPO | $1,673 |
| Cigna | Utah Connect/Local Plus | $1,673 |
| Deseret Mutual | All Other | $1,673 |
| EMI Health | Mint | $1,673 |
| EMI Health | Network Care | $1,673 |
| EMI | Commercial | $1,673 |
| First Choice of the Midwest | Commercial | $1,673 |
| First Choice | Commercial | $1,673 |
| Franklin County | Commercial | $1,673 |
| Global Excel | Commercial | $1,673 |
| Health Utah | Commercial | $1,673 |
| Humana | Commercial | $1,673 |
| Hygeia Corporation | Commercial | $1,673 |
| Juniper Systems | Commercial | $1,673 |
| LW Miller | Commercial | $1,673 |
| Managed Care Admin | Commercial | $1,673 |
| MedCare International | Commercial | $1,673 |
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All common services at IHC Health Services Inc., DBA Intermountain Primary Children's Hospital