CT abdomen and pelvis with contrast at CHI St. Alexius Health Devils Lake. CPT 74177.
What CHI St. Alexius Health Devils Lake publishes for this service, straight from its standard-charges file, last updated February 28, 2026.
Outpatient / ER
$1,951cash price (self-pay)
$4,645list price
$1,765–$4,413range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medica | Medicare|All Plans | $1,765 |
| BCBS - ND | Medicare|All Plans | $1,800 |
| BCBS - ND | Medicaid|All Plans | $2,462 |
| Sanford Health Plan | Commercial|All Plans | $3,344 |
| United | Commercial|New Business | $3,391 |
| United | Commercial|All Other Plans | $3,855 |
| Medica | Commercial|All Plans | $4,273 |
| Health Partners | Commercial|All Plans | $4,413 |
Inpatient
$1,951cash price (self-pay)
$4,645list price
$3,344–$4,413range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Sanford Health Plan | Commercial|All Plans | $3,344 |
| United | Commercial|New Business | $3,391 |
| United | Commercial|All Other Plans | $3,855 |
| Medica | Commercial|All Plans | $4,273 |
| Health Partners | Commercial|All Plans | $4,413 |
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