CT abdomen and pelvis with contrast at Sleepy Eye Medical Center. CPT 74177.
What Sleepy Eye Medical Center publishes for this service, straight from its standard-charges file, last updated March 31, 2026.
Outpatient / ER
$1,867cash price (self-pay)
$5,107list price
$218–$4,954range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medicare B MN J6 | Default | $218 |
| BCBSMN Blue Plus MCD Rep Plan DOS after 1/1/19 | Default | $700 |
| Blue Cross Blue Shield of MN | Default | $1,867 |
| Blue Cross Blue Shield of MN | PPO | $1,867 |
| Aetna | Medicare Advantage | $2,052 |
| HealthPartners | Medicare Advantage | $2,052 |
| Humana | Medicare Advantage | $2,052 |
| Medica | Medicare Advantage | $2,052 |
| Medicare A MN J6 | Default | $2,052 |
| Prime West | Medicare Advantage | $2,052 |
| South Country Health Alliance SCHA | Medicare Advantage | $2,052 |
| Ucare | Medicare Advantage | $2,052 |
| United Healthcare | Medicare Advantage | $2,094 |
| VA Community Care Network VACCN Region 1-3 Optum | All Plans | $2,094 |
| Blue Cross Blue Shield of MN | Medicare Advantage | $2,102 |
| Medicaid Minnesota | Default | $2,238 |
| Prime West | Default | $2,238 |
| South Country Health Alliance SCHA | Medicaid Replacement | $2,238 |
| Ucare | Default | $2,238 |
| Ucare | Medicaid Replacement | $2,238 |
| TriWest | Default | $2,387 |
| Medica | Default | $4,101 |
| HealthPartners | Default | $4,489 |
| UMR Onalaska Midwest Securities | Default | $4,509 |
| UMR Wausau/UHIS | Default | $4,509 |
| United Healthcare | Default | $4,509 |
| Sanford Health Plan | Default | $4,698 |
| Cigna | Default | $4,801 |
| Companion Life Insurance Company | Default | $4,801 |
| Group Resources PHCS | Default | $4,801 |
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