CT abdomen and pelvis with contrast at Sanford Canby Medical Center. CPT 74177.
What Sanford Canby Medical Center publishes for this service, straight from its standard-charges file, last updated March 4, 2026.
Outpatient / ER
$4,086cash price (self-pay)
$5,108list price
$375–$4,802range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Ucare | Medicaid Managed Care | $375 |
| Blue Cross Blue Shield of Minnesota | PMAP | $608 |
| Blue Cross Blue Shield of Minnesota | Commercial/Federal | $1,216 |
| Blue Cross Blue Shield of Minnesota | State Employees | $1,216 |
| Sanford Health Plan Align | Medicare Replacement | $2,329 |
| Ucare | Medicare Replacement | $2,503 |
| Aetna | Medicare Replacement | $2,523 |
| Blue Cross Blue Shield of Minnesota | Medicare Replacement | $2,523 |
| Great Plains Medicare Advantage | Medicare Replacement | $2,523 |
| Health Partners | Medicare Replacement | $2,523 |
| United Healthcare | Medicare Replacement | $2,523 |
| Primewest | Medicare Replacement | $2,574 |
| Primewest | Medicaid Managed Care | $2,809 |
| Security Health Plan | Commercial | $2,809 |
| Health Partners | State Employees | $3,519 |
| Sanford Health Plan | Group Health/True | $4,032 |
| Sanford Health Plan | SD Exchange True | $4,032 |
| Health Partners | Commercial | $4,086 |
| United Healthcare | Commercial + Top 20 | $4,265 |
| Aetna | Commercial | $4,439 |
| Ucare | Commercial | $4,488 |
| Medica | Choice | $4,490 |
| Cigna | Commercial | $4,597 |
| First Choice Health Network | Commercial | $4,597 |
| Healthez | Commercial | $4,597 |
| Multiplan | Commercial | $4,597 |
| Sanford Health Plan | Commercial/ND Pers | $4,744 |
| Sanford Health Plan | SD Exchange Commercial | $4,744 |
| Medica | Elect | $4,802 |
Inpatient
$4,086cash price (self-pay)
$5,108list price
$2,809–$4,832range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Security Health Plan | Commercial | $2,809 |
| Health Partners | State Employees | $3,519 |
| Sanford Health Plan | Group Health/True | $4,032 |
| Sanford Health Plan | SD Exchange True | $4,032 |
| Health Partners | Commercial | $4,086 |
| United Healthcare | Commercial + Top 20 | $4,265 |
| Aetna | Commercial | $4,439 |
| Ucare | Commercial | $4,488 |
| Medica | Choice | $4,515 |
| Cigna | Commercial | $4,597 |
| First Choice Health Network | Commercial | $4,597 |
| Healthez | Commercial | $4,597 |
| Multiplan | Commercial | $4,597 |
| Sanford Health Plan | Commercial/ND Pers | $4,744 |
| Sanford Health Plan | SD Exchange Commercial | $4,744 |
| Medica | Elect | $4,832 |
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