CT abdomen and pelvis with contrast at Maple Grove Hospital. CPT 74177.
What Maple Grove Hospital publishes for this service, straight from its standard-charges file, last updated September 25, 2026.
Outpatient / ER
$707cash price (self-pay)
$1,341list price
$259–$1,432range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Health Partners [1061] | Mgh Hp Govt Msho | $259 |
| Blue Cross [1021] | Mgh BCBS Pmap | $296 |
| Medicaid [1087] | Mgh Medicaid Mn | $344 |
| Blue Cross [1021] | Mgh BCBS Msho | $361 |
| Humana [2203] | Mgh Humana Med Adv | $361 |
| Medicare [1088] | Mgh Medicare | $361 |
| Ucare [1148] | Mgh Ucare Pmap | $361 |
| Health Partners [1061] | Mgh Hp Med Adv | $362 |
| Medica [1086] | Mgh Medica Med Adv | $365 |
| Ucare [1148] | Mgh Ucare Med Adv | $372 |
| Blue Cross [1021] | Mgh BCBS Med Adv | $372 |
| Ucare [1148] | Mgh Ucare Msho | $372 |
| United Healthcare [2204] | Mgh UHC Med Adv | $376 |
| Allina Health-Aetna [2201] | Mgh Allina Health Aetna Medicare | $392 |
| Medica [1086] | Medica Choice Care | $618 |
| Ucare [1148] | Mgh Ucare Ifb | $661 |
| Blue Cross [1021] | Mgh Xr Hb BCBS Federal | $669 |
| Blue Cross [1021] | Mgh Xr Hb BCBS Aware | $681 |
| Cigna Health Partners [1242] | Mgh Hp Cigna | $709 |
| Health Partners [1061] | Mgh Hp Federal | $709 |
| Health Partners [1061] | Mgh Hp Comm | $709 |
| Medica [1086] | Mgh Medica Msho | $715 |
| America'S PPO [1010] | America'S PPO Healthez Reimbursement Contract | $908 |
| America'S PPO [1010] | America'S PPO Reimbursement Contract | $966 |
| Phcs [1172] | Phcs Reimbursement Contract | $1,006 |
| Multiplan [1176] | Multiplan Reimbursement Contract | $1,073 |
| Medica [1086] | Medica Acclaim | $1,299 |
| Medica [1086] | Medica Fv Nm - Aco Vantage | $1,334 |
| MEDICA [1086] | MEDICA COMMERCIAL (With WH) | $1,432 |
Billed more than this?
Scan my billSnap a photo of your bill. We compare every line with these prices and coding rules, free.