CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Primary Children's Hospital

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 74177
  • Insurance Median: $1,673
  • Cash Discount Price: $1,767
  • vs. Medicare Baseline: 4.69x Medicare
The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Primary Children's Hospital is $1,673. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,767. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 4.69x the Medicare baseline. Located in 100 North Mario Capecchi Drive, Salt Lake City, UT.
Cash / Self-Pay
$1,767

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,673

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: $1,767 (496%)
Insurance Median: $1,673 (469%)
Cash: $1,767 (496% of Medicare)
Ins. Median: $1,673 (469% 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 469% of the Medicare baseline (a markup of 369%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
American Health $85 - $1,343 24%
Health Plan Of Nevada $85 - $218 24%
Healthy U $85 - $218 24%
Molina $85 - $1,979 24%
Selecthealth $85 - $1,979 24%
Southwest Behavioral Health $85 - $350 24%
UnitedHealthcare $85 - $1,979 24%
Tricare $342 96%
Triwest $342 96%
Donor Connect $848 - $938 238%
Aetna $1,673 - $2,003 469%
Awh Connected $1,673 - $2,003 469%
Byu Athletics $1,673 - $1,979 469%
Campbell Scientific $1,673 - $1,979 469%
Cigna $1,673 - $1,979 469%
Deseret Mutual $1,673 - $1,979 469%
Emi $1,673 - $1,979 469%
Emi Health $1,673 - $1,979 469%
First Choice $1,673 - $1,979 469%
First Choice Of The Midwest $1,673 - $1,979 469%
Franklin County $1,673 - $1,979 469%
Global Excel $1,673 - $1,979 469%
Health Utah $1,673 - $1,979 469%
Humana $1,673 - $1,979 469%
Hygeia Corporation $1,673 - $1,979 469%
Ifit $1,673 - $1,979 469%
Juniper Systems $1,673 - $1,979 469%
Lw Miller $1,673 - $1,979 469%
Managed Care Admin $1,673 - $1,979 469%
Medcare International $1,673 - $1,979 469%
Motivhealth $1,673 - $1,979 469%
Pehp $1,673 - $1,979 469%
Prodegi Corp Benefit $1,673 - $1,979 469%
Tanner Llc $1,673 - $1,979 469%
Uofu $1,673 - $1,979 469%
Utah Tech $1,673 - $1,979 469%
Wise Network $1,673 - $1,979 469%
First Health $1,696 - $2,003 476%
Blue Cross Blue Shield $1,720 - $2,026 483%
Springtide $1,720 - $2,026 483%
Utah Behavioral Health Network $1,908 535%
Altius Mhnet Behavioral Health $2,073 582%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 100 North Mario Capecchi Drive, Salt Lake City, UT 84113
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Childrens