CT abdomen and pelvis with contrast at Grand Itasca Clinic and Hospital. CPT 74177.
What Grand Itasca Clinic and Hospital publishes for this service, straight from its standard-charges file, last updated January 28, 2026.
Outpatient / ER
$158cash price (self-pay)
$1,490list price
$59.12–$1,851range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Cross of Minnesota | PMAP | $182 |
| Health Partners | PMAP | $218 |
| Medica | AccessAbility | $238 |
| Medica | Managed Medicaid | $238 |
| Medica | Medicare Advantage Non-SNP | $238 |
| Itasca Medical Care | Managed Medicaid | $277 |
| Primewest | Managed Medicaid | $277 |
| Itasca Medical Care | Medicare Advantage/MSHO | $296 |
| Medica | MSHO-Dual/Medicare Advantage SNP | $296 |
| Primewest | MSHO | $296 |
| Sanford Health Plan | Medicare Advantage | $296 |
| Security Health Plan | Medicare Advantage | $296 |
| United Healthcare | Medicare Advantage | $296 |
| WellCare | Medicare Advantage | $296 |
| Blue Cross of Minnesota | Medicare Advantage | $307 |
| UCare | Medicare Advantage/MSHO | $310 |
| UCare | PMAP | $313 |
| Health Partners | Medicare Advantage | $313 |
| Health Partners | Medicare Cost | $325 |
| Blue Cross of Minnesota | Aware Federal | $480 |
| Blue Cross of Minnesota | Aware/Blue Plus | $488 |
| Health Partners | Federal | $489 |
| Health Partners | Commercial | $498 |
| Health Partners | Cigna Commercial | $523 |
| Health Partners | Cigna Great West | $623 |
| UCare | Individual and Family Plans | $705 |
| Medica | Commercial | $874 |
| Sanford Health Plan | Commercial | $878 |
| Security Health Plan | Commercial | $1,106 |
| United Healthcare | Commercial | $1,174 |
Inpatient
$779cash price (self-pay)
$1,832list price
$833–$1,823range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Health Partners | Medicare Cost | $834 |
| Health Partners | PMAP | $849 |
| Sanford Health Plan | Commercial | $1,079 |
| Security Health Plan | Commercial | $1,374 |
| Health Partners | Federal | $1,433 |
| Health Partners | Commercial | $1,458 |
| United Healthcare | Commercial | $1,472 |
| First Health | Commercial | $1,502 |
| Medica | Commercial | $1,524 |
| Health Partners | Cigna Commercial | $1,531 |
| MultiPlan | Commercial | $1,557 |
| Private Healthcare Systems | Commercial | $1,557 |
| Wisconsin Physician Services | Commercial | $1,649 |
| America's PPO | Commercial/EZCare/Health EZ | $1,685 |
| Health Partners | Cigna Great West | $1,823 |
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