CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Holy Cross Hospital - Salt Lake

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74177
Insurance Median: $3,120
Cash Discount Price: $2,724
vs. Medicare Baseline: 8.75x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Holy Cross Hospital - Salt Lake is $3,120. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,724. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 8.75x the Medicare baseline. Located in 1050 East South Temple, Salt Lake City, UT.

Cash / Self-Pay

$2,724

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,120

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$356.43

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $356.43 (100%)

Cash / Self-Pay: $2,724 (764%)

Insurance Median: $3,120 (875%)

Cash: $2,724 (764% of Medicare)

Ins. Median: $3,120 (875% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $356.43 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 875% of the Medicare baseline (a markup of 775%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Denver Health	$170	48%
Health Choice	$170	48%
Medicaid / KanCare	$170	48%
Rocky Mountain Health Plan	$170	48%
Uuhp	$170 - $1,397	48%
Humana	$195	55%
Medicare (plans)	$195	55%
Cigna	$243 - $5,448	68%
Employer Direct Healthcare	$245	69%
Motivhealth	$259	73%
Centura Employee Plan	$337	95%
Blue Cross Blue Shield	$366 - $4,086	103%
Molina	$459 - $2,924	129%
UnitedHealthcare	$480	135%
Pehp	$1,554 - $6,809	436%
Aetna	$3,008 - $5,754	844%
Wise	$3,541 - $3,609	993%
Deseret Mutual Benefit Administrators	$4,181	1173%
Select Health	$4,506	1264%
Multiplan	$4,699 - $6,197	1318%
Emi Health	$6,809	1910%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $2,724.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 74177.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Holy Cross Hospital - Salt Lake is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 74177.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.