CT abdomen and pelvis with contrast at Sanford Jackson Hospital. CPT 74177.
What Sanford Jackson Hospital publishes for this service, straight from its standard-charges file, last updated March 4, 2026.
Outpatient / ER
$4,630cash price (self-pay)
$5,787list price
$375–$5,440range 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 | $1,817 |
| Ucare | Medicare Replacement | $1,950 |
| Wellmark SD | Medicare Replacement | $1,950 |
| Aetna | Medicare Replacement | $1,968 |
| Great Plains Medicare Advantage | Medicare Replacement | $1,968 |
| Health Partners | Medicare Replacement | $1,968 |
| United Healthcare | Medicare Replacement | $1,968 |
| Primewest | Medicare Replacement | $2,005 |
| Blue Cross Blue Shield of Minnesota | Medicare Replacement | $2,005 |
| Primewest | Medicaid Managed Care | $2,164 |
| Sanford Health Plan | Group Health/True | $3,101 |
| Sanford Health Plan | SD Exchange True | $3,101 |
| Security Health Plan | Commercial | $3,183 |
| Sanford Health Plan | Commercial/ND Pers | $3,648 |
| Sanford Health Plan | SD Exchange Commercial | $3,648 |
| Health Partners | State Employees | $3,987 |
| Health Partners | Commercial | $4,630 |
| United Healthcare | Commercial + Top 20 | $4,832 |
| Aetna | Commercial | $5,029 |
| Ucare | Commercial | $5,084 |
| Medica | Choice | $5,087 |
| Cigna | Commercial | $5,208 |
| First Choice Health Network | Commercial | $5,208 |
| Healthez | Commercial | $5,208 |
| Multiplan | Commercial | $5,208 |
| Medica | Elect | $5,440 |
Inpatient
$4,630cash price (self-pay)
$5,787list price
$3,101–$5,475range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Sanford Health Plan | Group Health/True | $3,101 |
| Sanford Health Plan | SD Exchange True | $3,101 |
| Security Health Plan | Commercial | $3,183 |
| Sanford Health Plan | Commercial/ND Pers | $3,648 |
| Sanford Health Plan | SD Exchange Commercial | $3,648 |
| Health Partners | State Employees | $3,987 |
| Health Partners | Commercial | $4,630 |
| United Healthcare | Commercial + Top 20 | $4,832 |
| Aetna | Commercial | $5,029 |
| Ucare | Commercial | $5,084 |
| Medica | Choice | $5,116 |
| Cigna | Commercial | $5,208 |
| First Choice Health Network | Commercial | $5,208 |
| Healthez | Commercial | $5,208 |
| Multiplan | Commercial | $5,208 |
| Medica | Elect | $5,475 |
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