CT abdomen and pelvis with contrast at Intermountain Health Logan Regional Hospital. CPT 74177.
What Intermountain Health Logan Regional 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 |
|---|---|
| Health Plan of Nevada | Medicaid | $218 |
| SelectHealth | Medicaid | $218 |
| Aetna | Medicare Adv HMO | $218 |
| Aetna | Medicare Adv PPO | $218 |
| American Health | Medicare Adv UT HMO I-SNP | $218 |
| Health Partners of Nevada | Medicare Advantage | $218 |
| Healthy U | Medicaid | $218 |
| Humana | Medicare Choice PPO | $218 |
| Molina | Medicaid | $218 |
| Molina | Medicare Advantage | $218 |
| Molina | Medicare Choice Care HMO | $218 |
| Molina | Medicare Complete Care HMO SNP | $218 |
| Regence BCBS | MedAdvantage PPO | $218 |
| SelectHealth | Medicare Advantage | $218 |
| Southwest Behavioral Health | Behavioral Health | $218 |
| UHC | Medicare Advantage | $218 |
| Intermountain Caregiver Plan | Share Network | $1,311 |
| Intermountain Caregiver Plan | Med Network | $1,349 |
| SelectHealth | CHP | $1,580 |
| SelectHealth | Commercial | $1,580 |
| SelectHealth | FEHBP | $1,580 |
| SelectHealth | SM Individual ACA | $1,580 |
| EMI | Commercial | $2,090 |
| Deseret Mutual | All Other | $2,094 |
| Deseret Mutual | Select | $2,094 |
| Campbell Scientific | Commercial | $2,103 |
| Franklin County | Commercial | $2,103 |
| Juniper Systems | Commercial | $2,103 |
| LW Miller | Commercial | $2,103 |
| Regence BCBS | BlueOption | $2,242 |
Inpatient
$3,214cash price (self-pay)
$4,286list price
$90.00–$4,071range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Donor Connect | Other | $90.00 |
| Health Plan of Nevada | Medicaid | $1,286 |
| Intermountain Caregiver Plan | Med Network | $1,817 |
| Intermountain Caregiver Plan | Share Network | $1,817 |
| Campbell Scientific | Commercial | $3,000 |
| Franklin County | Commercial | $3,000 |
| Juniper Systems | Commercial | $3,000 |
| LW Miller | Commercial | $3,000 |
| CorVel Corporation | Workers Comp | $3,214 |
| Corporation of the President | Workers Comp | $3,214 |
| Injury Care of Nevada | Workers Comp | $3,214 |
| AG Administrators | USU Athletics | $3,643 |
| Altius MHNet Behavioral Health | Behavioral Health | $3,643 |
| BYU Athletics | Commercial | $3,643 |
| BYU Risk Management | Workers Comp | $3,643 |
| Cigna | Open Access Flex | $3,643 |
| Global Excel | Commercial | $3,643 |
| MedCare International | Commercial | $3,643 |
| AWH Connected | Connected Utah | $3,656 |
| Deseret Mutual | All Other | $3,656 |
| Deseret Mutual | Select | $3,656 |
| EMI Health | Mint | $3,656 |
| EMI Health | Network Care | $3,656 |
| EMI | Commercial | $3,656 |
| Managed Care Admin | Commercial | $3,656 |
| PEHP | Advantage Non-State | $3,656 |
| PEHP | Advantage State | $3,656 |
| PEHP | Capital Care | $3,656 |
| Aetna | Connected | $4,071 |
| Aetna | Extended | $4,071 |
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All common services at Intermountain Health Logan Regional Hospital