CT abdomen and pelvis with contrast at Sanford Behavioral Health Thief River Falls. CPT 74177.
What Sanford Behavioral Health Thief River Falls publishes for this service, straight from its standard-charges file, last updated March 4, 2026.
Outpatient / ER
$3,747cash price (self-pay)
$4,684list price
$375–$4,403range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Primewest | Medicaid Managed Care | $375 |
| Ucare | Medicaid Managed Care | $375 |
| Blue Cross Blue Shield of Minnesota | PMAP | $608 |
| Blue Cross Blue Shield of Minnesota | Commercial/Federal | $1,216 |
| Sanford Health Plan Align | Medicare Replacement | $1,780 |
| Ucare | Medicare Replacement | $1,911 |
| Aetna | Medicare Replacement | $1,930 |
| Blue Cross Blue Shield of Minnesota | Medicare Replacement | $1,930 |
| Great Plains Medicare Advantage | Medicare Replacement | $1,930 |
| Health Partners | Medicare Replacement | $1,930 |
| United Healthcare | Medicare Replacement | $1,930 |
| Primewest | Medicare Replacement | $1,967 |
| Sanford Health Plan | Group Health/TRUE | $2,510 |
| Sanford Health Plan | SD Exchange True | $2,510 |
| Security Health Plan | Commercial | $2,576 |
| Sanford Health Plan | Commercial/ND Pers | $2,952 |
| Sanford Health Plan | SD Exchange Commercial | $2,952 |
| Health Partners | Commercial | $3,794 |
| United Healthcare | Commercial + Top 20 | $3,911 |
| Aetna | Commercial | $4,070 |
| Ucare | Commercial | $4,115 |
| Medica | Choice | $4,117 |
| Cigna | Commercial | $4,216 |
| First Choice Health Network | Commercial | $4,216 |
| Healthez | Commercial | $4,216 |
| Multiplan | Commercial | $4,216 |
| Medica | Elect | $4,403 |
Inpatient
$3,747cash price (self-pay)
$4,684list price
$2,510–$4,431range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Sanford Health Plan | Group Health/TRUE | $2,510 |
| Sanford Health Plan | SD Exchange True | $2,510 |
| Security Health Plan | Commercial | $2,576 |
| Sanford Health Plan | Commercial/ND Pers | $2,952 |
| Sanford Health Plan | SD Exchange Commercial | $2,952 |
| Health Partners | Commercial | $3,794 |
| United Healthcare | Commercial + Top 20 | $3,911 |
| Aetna | Commercial | $4,070 |
| Ucare | Commercial | $4,115 |
| Medica | Choice | $4,141 |
| Cigna | Commercial | $4,216 |
| First Choice Health Network | Commercial | $4,216 |
| Healthez | Commercial | $4,216 |
| Multiplan | Commercial | $4,216 |
| Medica | Elect | $4,431 |
Billed more than this?
Scan my billSnap a photo of your bill. We compare every line with these prices and coding rules, free.
All common services at Sanford Behavioral Health Thief River Falls