CT abdomen and pelvis with contrast at Essentia Health St. Mary's-Detroit Lakes. CPT 74177.
What Essentia Health St. Mary's-Detroit Lakes publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$2,508cash price (self-pay)
$3,907list price
$257–$3,360range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Itasca Med Care | Medicaid | $357 |
| Primewest | Medicaid | $371 |
| Advocare/Security Health | Medicare | $375 |
| BLUE CROSS MEDICARE ADVANTAGE CORE | Medicare | $375 |
| Freedom Blue PPO | Medicare | $375 |
| HEALTHPARTNERS CARE MSHO / MCR ADV | Medicare | $375 |
| IMCARE MSHO PCC PRIME | Medicare | $375 |
| IMCARE MSHO REF REQ | Medicare | $375 |
| MEDICA ADVANTAGE SOLUTIONS | Medicare | $375 |
| MEDICA MSHO/Dual Solutions | Medicare | $375 |
| MEDICA PRIME SOLUTION GROUP | Medicare | $375 |
| MEDICARE ADV PFFS | Medicare | $375 |
| ND VA ADMINISTRATION | Medicare | $375 |
| OUT OF STATE BCBS MEDICARE ADVANTAGE | Medicare | $375 |
| PRIMEWEST MSHO | Medicare | $375 |
| Platinum Blue/Vantage Blue | Medicare | $375 |
| SECURE BLUE MSHO | Medicare | $375 |
| SECURITY HEALTH MEDICARE | Medicare | $375 |
| UBH COST PLAN | Medicare | $375 |
| UBH MSHO/MEDICARE REPLACEMENT | Medicare | $375 |
| UBH MSHO | Medicare | $375 |
| BCBS MN | Medicaid | $1,008 |
| BCBS PLUS PMAP PCC PRIME | Medicaid | $1,008 |
| Sanford HealthPlan | Commercial-NDPERS | $1,154 |
| Sanford HealthPlan | Commercial | $1,198 |
| HealthPartners CARE PMAP | Medicaid | $1,520 |
| MN BCBS Commercial | BCBS MN | $1,726 |
| Medica Uplan | Commercial | $2,485 |
| HealthPartners | SHP | $2,626 |
| Medica | Commercial-FI | $2,727 |
Inpatient
$2,508cash price (self-pay)
$3,907list price
$1,676–$3,360range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Sanford HealthPlan | Commercial-NDPERS | $1,676 |
| Sanford HealthPlan | Commercial | $1,764 |
| Ucare | Commercial | $2,571 |
| BCBS MN | Medicaid | $2,612 |
| BCBS PLUS PMAP PCC PRIME | Medicaid | $2,612 |
| WEA | Commercial-Narrow Network | $2,813 |
| MN BCBS Commercial | BCBS MN | $2,902 |
| BCBS WI | Commercial | $2,969 |
| WEA | Commercial | $3,008 |
| America's PPO | Commercial | $3,028 |
| WPS | Commercial | $3,243 |
| Aetna First Health | Commercial | $3,321 |
| HealthEOS | Commercial | $3,360 |
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All common services at Essentia Health St. Mary's-Detroit Lakes