CMS Price Transparency Data

CT scan, abdomen and pelvis (no contrast)

Facility: Holy Cross Hospital-Davis

Billing Code: 74176 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74176
Insurance Median: $3,109
Cash Discount Price: $2,444
vs. Medicare Baseline: 12.75x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (no contrast) at Holy Cross Hospital-Davis is $3,109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,444. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 12.75x the Medicare baseline. Located in 1600 West Antelope Drive, Layton, UT.

Cash / Self-Pay

$2,444

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,109

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)

Cash / Self-Pay: $2,444 (1003%)

Insurance Median: $3,109 (1275%)

Cash: $2,444 (1003% of Medicare)

Ins. Median: $3,109 (1275% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 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 1275% of the Medicare baseline (a markup of 1175%). 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
Medicaid / KanCare	$81	33%
Uuhp	$81 - $714	33%
Humana	$93	38%
Medicare (plans)	$93	38%
Select Health	$99 - $3,003	41%
Employer Direct Healthcare	$117	48%
Motivhealth	$123	50%
Molina	$218 - $2,623	89%
Blue Cross Blue Shield	$233 - $3,665	96%
Cigna	$243 - $4,887	100%
Centura Employee Plan	$337	138%
Pehp	$1,554 - $3,543	637%
Aetna	$2,699 - $5,162	1107%
Wise	$3,177 - $3,238	1303%
Deseret Mutual Benefit Administrators	$3,751	1539%
Multiplan	$4,215 - $5,559	1729%
UnitedHealthcare	$4,429 - $6,109	1817%
Emi Health	$5,315	2180%

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 $2,444.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 74176.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Holy Cross Hospital-Davis is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 74176.
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.