CT abdomen and pelvis with contrast at Jacobson Memorial Hospital Care Center. CPT 74177.
What Jacobson Memorial Hospital Care Center publishes for this service, straight from its standard-charges file, last updated March 1, 2026.
Outpatient / ER
$2,164cash price (self-pay)
$2,885list price
$1,731–$4,039range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna | Commercial | $1,731 |
| North Dakota Medicaid | Medicaid | $2,066 |
| TriCare | VA | $2,164 |
| United Healthcare | Commercial | $2,199 |
| Medica | Commercial | $2,308 |
| TLC Advantage | Commercial | $2,308 |
| Cigna | Commercial | $2,597 |
| Healthpartners | Commercial | $2,597 |
| Healthpartners Medicare Advantage | Medicare Replacement | $2,597 |
| Multiplan Commercial | Commercial | $2,597 |
| Aetna | Medicare Replacement | $2,885 |
| North Dakota BCBS | Commercial | $2,885 |
| Humana Medicare | Medicare Replacement | $2,885 |
| Medica Medicare | Medicare Replacement | $2,885 |
| Multiplan Medicare | Medicare Replacement | $2,885 |
| NextBlue | Medicare Replacement | $2,885 |
| Sanford Health Plan | Commercial | $2,885 |
| United Healthcare | Medicare Replacement | $2,885 |
| Noridian Medicare | Medicare | $3,462 |
| North Dakota BCBS Medicaid Expansion | Medicaid Expansion | $4,039 |
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All common services at Jacobson Memorial Hospital Care Center