CT abdomen and pelvis with contrast at Intermountain Health Spanish Fork Hospital. CPT 74177.
What Intermountain Health Spanish Fork Hospital publishes for this service, straight from its standard-charges file, last updated August 5, 2026.
Outpatient / ER
$3,571cash price (self-pay)
$4,762list price
$85.32–$4,286range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Health Plan of Nevada | Medicaid | $218 |
| SelectHealth | Med Individual ACA | $218 |
| SelectHealth | Medicaid | $218 |
| SelectHealth | Signature Individual ACA | $218 |
| SelectHealth | Value Individual ACA | $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 | Medicare Advantage | $218 |
| Molina | Medicare Complete Care HMO SNP | $218 |
| Regence BCBS | MedAdvantage PPO | $218 |
| SelectHealth | Medicare Advantage | $218 |
| UHC | Medicare Advantage | $218 |
| Intermountain Caregiver Plan | Share Network | $1,450 |
| SelectHealth | FEHBP | $1,450 |
| SelectHealth | SelectShare | $1,450 |
| SelectHealth | SelectValue | $1,450 |
| Intermountain Caregiver Plan | CHP | $1,588 |
| Intermountain Caregiver Plan | Med Network | $1,588 |
| SelectHealth | SelectMed/CHIP | $1,588 |
| SelectHealth | SelectCare | $1,645 |
| EMI | Commercial | $1,889 |
| Deseret Mutual | Commercial | $1,972 |
| Deseret Mutual | Connected Utah | $1,972 |
| Regence BCBS | BlueOption | $2,073 |
| AWH Connected | Connected Utah | $2,139 |
| EMI Health | Mint | $2,255 |
Inpatient
$3,571cash price (self-pay)
$4,762list price
$310–$4,286range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Donor Connect | Other | $310 |
| SelectHealth | Med Individual ACA | $1,419 |
| Health Plan of Nevada | Medicaid | $1,429 |
| Intermountain Caregiver Plan | Share Network | $2,019 |
| SelectHealth | FEHBP | $2,019 |
| Intermountain Caregiver Plan | CHP | $2,295 |
| Intermountain Caregiver Plan | Med Network | $2,295 |
| EMI | Commercial | $2,571 |
| Deseret Mutual | Commercial | $2,738 |
| Deseret Mutual | Connected Utah | $2,738 |
| Regence BCBS | BlueOption | $2,940 |
| Cigna | Open Access Flex | $3,000 |
| AWH Connected | Connected Utah | $3,024 |
| EMI Health | Mint | $3,305 |
| EMI Health | Network Care | $3,305 |
| PEHP | Advantage State | $3,314 |
| BYU Risk Management | Workers Comp | $3,333 |
| Corporation of the President | Workers Comp | $3,333 |
| Regence BCBS | High Performance | $3,333 |
| Regence BCBS | FEHBP | $3,357 |
| PEHP | Advantage Non-State | $3,381 |
| BYU Athletics | Commercial | $3,429 |
| Campbell Scientific | Commercial | $3,429 |
| CorVel Corporation | Workers Comp | $3,429 |
| Franklin County | Commercial | $3,429 |
| Juniper Systems | Commercial | $3,429 |
| LW Miller | Commercial | $3,429 |
| Injury Care of Nevada | Workers Comp | $3,571 |
| Regence BCBS | Traditional | $3,619 |
| Managed Care Admin | Commercial | $3,714 |
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All common services at Intermountain Health Spanish Fork Hospital