CT abdomen and pelvis with contrast at Intermountain Health Garfield Memorial Hospital. CPT 74177.
What Intermountain Health Garfield Memorial Hospital publishes for this service, straight from its standard-charges file, last updated August 5, 2026.
Outpatient / ER
$3,214cash price (self-pay)
$4,286list price
$85.32–$4,114range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna | Aetna Medicare HMO | $218 |
| Aetna | Aetna Medicare PPO | $218 |
| Health Choice Utah | Health Choice Utah-Medicaid | $218 |
| Healthy U | Medicaid | $218 |
| Medicare Intermountain Healthcare Nevada | Medicare Intermountain Heal | $218 |
| Molina Healthcare of Utah | Molina Healthcare Medicaid HMO | $218 |
| Molina Healthcare of Utah | Molina Medicare Complete Care HMO SNP | $218 |
| Molina | Medicaid | $218 |
| SelectHealth | Medicaid | $218 |
| SelectHealth | Medicare Advantage | $218 |
| SelectHealth | SelectHealth Community Care-Medicaid | $218 |
| TriWest | Veterans Choice | $218 |
| UofU | Healthy U - Medicaid | $218 |
| Aetna | Aetna Standard Network AKA Aetna Health Plan Network for Utah | $2,639 |
| Aetna | Aetna Utah Connected Network | $2,639 |
| BYU Athletic Department | Athletic Services | $2,639 |
| Campbell Scientific | Samera Health | $2,639 |
| Cigna Healthcare | CIGNA Managed Care (HMO or Open Access Plus aka OAP | $2,639 |
| Cigna | PPO/EPO | $2,639 |
| Deseret Mutual | DMBA | $2,639 |
| EMI Health | EMI Health | $2,639 |
| EMI Health | EMI Health Choice | $2,639 |
| EMI Health | EMI Health Network Care | $2,639 |
| EMI Health | Mint | $2,639 |
| Franklin County | Samera Health | $2,639 |
| Health Utah | MotivHealth Health Utah | $2,639 |
| Juniper Systems | Samera Health | $2,639 |
| LW Miller | Samera Health | $2,639 |
| Managed Care Administrators, Inc. | Managed Care Administrators, Inc. | $2,639 |
| MotivHealth | MotivHealth | $2,639 |
Inpatient
$3,214cash price (self-pay)
$4,286list price
$2,208–$4,071range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Health Choice Utah | Health Choice Utah-Medicaid | $3,814 |
| Healthy U | Medicaid | $3,814 |
| Molina Healthcare of Utah | Molina Healthcare Medicaid HMO | $3,814 |
| Molina | Medicaid | $3,814 |
| Aetna | Aetna Extended Network | $4,071 |
| Aetna | Aetna Standard Network AKA Aetna Health Plan Network for Utah | $4,071 |
| Aetna | Aetna Utah Connected Network | $4,071 |
| Aetna | Aetna Whole Health Connected Utah Network | $4,071 |
| BCBS OOS - PPO | BCBS Association-Blue Card PPO Plan | $4,071 |
| BCBS OOS -TRAD | BCBS Association-Blue Card Traditional Plan | $4,071 |
| BYU Athletic Department | Athletic Services | $4,071 |
| Campbell Scientific | Samera Health | $4,071 |
| Cigna Healthcare | CIGNA Managed Care (HMO or Open Access Plus aka OAP | $4,071 |
| Cigna Healthcare | CIGNA Open Access Flex | $4,071 |
| Cigna | PPO/EPO | $4,071 |
| Deseret Mutual | DMBA | $4,071 |
| EMI Health | EMI Health | $4,071 |
| EMI Health | EMI Health Choice | $4,071 |
| EMI Health | EMI Health Network Care | $4,071 |
| EMI Health | Mint | $4,071 |
| Franklin County | Samera Health | $4,071 |
| Health Utah | MotivHealth Health Utah | $4,071 |
| Hygeia Corporation | Hygeia Corporation | $4,071 |
| Juniper Systems | Samera Health | $4,071 |
| LW Miller | Samera Health | $4,071 |
| Managed Care Administrators, Inc. | Managed Care Administrators, Inc. | $4,071 |
| MedCare International | Commercial | $4,071 |
| Molina Healthcare of Utah | CHIP - Molina | $4,071 |
| Molina | CHIP | $4,071 |
| MotivHealth | MotivHealth | $4,071 |
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All common services at Intermountain Health Garfield Memorial Hospital