CT abdomen and pelvis with contrast at Sanford Westbrook Hospital. CPT 74177.
What Sanford Westbrook Hospital publishes for this service, straight from its standard-charges file, last updated March 4, 2026.
Outpatient / ER
$4,656cash price (self-pay)
$5,820list price
$375–$5,471range 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 | $2,491 |
| Ucare | Medicare Replacement | $2,671 |
| Wellmark SD | Medicare Replacement | $2,671 |
| Aetna | Medicare Replacement | $2,700 |
| Great Plains Medicare Advantage | Medicare Replacement | $2,700 |
| Health Partners | Medicare Replacement | $2,700 |
| United Healthcare | Medicare Replacement | $2,700 |
| Primewest | Medicare Replacement | $2,750 |
| Primewest | Medicaid Managed Care | $2,945 |
| Security Health Plan | Commercial | $3,201 |
| Health Partners | State Employees | $4,010 |
| Sanford Health Plan | Group Health/True | $4,594 |
| Sanford Health Plan | SD Exchange True | $4,594 |
| Health Partners | Commercial | $4,656 |
| United Healthcare | Commercial + Top 20 | $4,860 |
| Aetna | Commercial | $5,058 |
| Ucare | Commercial | $5,113 |
| Medica | Choice | $5,116 |
| Cigna | Commercial | $5,238 |
| First Choice Health Network | Commercial | $5,238 |
| Healthez | Commercial | $5,238 |
| Multiplan | Commercial | $5,238 |
| Sanford Health Plan | Commercial/ND Pers | $5,405 |
| Sanford Health Plan | SD Exchange Commercial | $5,405 |
| Medica | Elect | $5,471 |
Inpatient
$4,656cash price (self-pay)
$5,820list price
$3,201–$5,506range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Security Health Plan | Commercial | $3,201 |
| Health Partners | State Employees | $4,010 |
| Sanford Health Plan | Group Health/True | $4,594 |
| Sanford Health Plan | SD Exchange True | $4,594 |
| Health Partners | Commercial | $4,656 |
| United Healthcare | Commercial + Top 20 | $4,860 |
| Aetna | Commercial | $5,058 |
| Ucare | Commercial | $5,113 |
| Medica | Choice | $5,145 |
| Cigna | Commercial | $5,238 |
| First Choice Health Network | Commercial | $5,238 |
| Healthez | Commercial | $5,238 |
| Multiplan | Commercial | $5,238 |
| Sanford Health Plan | Commercial/ND Pers | $5,405 |
| Sanford Health Plan | SD Exchange Commercial | $5,405 |
| Medica | Elect | $5,506 |
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