CT abdomen and pelvis with contrast at Essentia Health-Holy Trinity Hospital (Graceville). CPT 74177.
What Essentia Health-Holy Trinity Hospital (Graceville) publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$2,528cash price (self-pay)
$3,421list price
$357–$3,096range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Itasca Med Care | Medicaid | $357 |
| Primewest | Medicaid | $371 |
| HealthPartners CARE PMAP | Medicaid | $1,331 |
| Medica Access | Medicaid | $1,362 |
| Sanford HealthPlan | Commercial-NDPERS | $1,467 |
| Sanford HealthPlan | Commercial | $1,545 |
| BCBS Nd | BCBS Mn | $1,830 |
| HealthPartners | SHP | $2,080 |
| Advocare/Security Health | Medicare | $2,121 |
| BLUE CROSS MEDICARE ADVANTAGE CORE | Medicare | $2,121 |
| Freedom Blue PPO | Medicare | $2,121 |
| HEALTHPARTNERS CARE MSHO / MCR ADV | Medicare | $2,121 |
| IMCARE MSHO PCC PRIME | Medicare | $2,121 |
| IMCARE MSHO REF REQ | Medicare | $2,121 |
| MEDICA ADVANTAGE SOLUTIONS | Medicare | $2,121 |
| MEDICA MSHO/Dual Solutions | Medicare | $2,121 |
| MEDICA PRIME SOLUTION GROUP | Medicare | $2,121 |
| MEDICARE ADV PFFS | Medicare | $2,121 |
| ND VA ADMINISTRATION | Medicare | $2,121 |
| OUT OF STATE BCBS MEDICARE ADVANTAGE | Medicare | $2,121 |
| PRIMEWEST MSHO | Medicare | $2,121 |
| Platinum Blue/Vantage Blue | Medicare | $2,121 |
| SECURE BLUE MSHO | Medicare | $2,121 |
| SECURITY HEALTH MEDICARE | Medicare | $2,121 |
| UBH COST PLAN | Medicare | $2,121 |
| UBH MSHO/MEDICARE REPLACEMENT | Medicare | $2,121 |
| UBH MSHO | Medicare | $2,121 |
| Cigna | Commercial | $2,275 |
| HealthPartners PCC Prime | Commercial | $2,275 |
| HealthPartners | Commercial | $2,275 |
Inpatient
$2,528cash price (self-pay)
$3,421list price
$1,331–$3,096range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| HealthPartners CARE PMAP | Medicaid | $1,331 |
| Sanford HealthPlan | Commercial-NDPERS | $1,467 |
| Sanford HealthPlan | Commercial | $1,545 |
| BCBS MN | Medicaid | $1,882 |
| BLUE PLUS PMAP PCC PRIME | Medicaid | $1,882 |
| HealthPartners | SHP | $2,080 |
| Medica Access | Medicaid | $2,131 |
| Ucare | Commercial | $2,251 |
| Cigna | Commercial | $2,275 |
| HealthPartners PCC Prime | Commercial | $2,275 |
| HealthPartners | Commercial | $2,275 |
| MN BCBS Commercial | BCBS MN | $2,395 |
| WEA | Commercial-Narrow Network | $2,463 |
| WEA | Commercial | $2,634 |
| America's PPO | Commercial | $2,651 |
| WPS | Commercial | $2,839 |
| Medica Uplan | Commercial | $2,843 |
| Medica | Commercial-FI | $2,843 |
| Medica | Commercial-SI | $2,843 |
| Aetna First Health | Commercial | $2,908 |
| Medica | IFB ACO | $2,993 |
| Medica Choice | Commercial | $3,082 |
| UHC | Commercial | $3,096 |
| UMR | Commercial | $3,096 |
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All common services at Essentia Health-Holy Trinity Hospital (Graceville)