CT abdomen and pelvis with contrast at Sanford Medical Center Mayville. CPT 74177.
What Sanford Medical Center Mayville publishes for this service, straight from its standard-charges file, last updated March 4, 2026.
Outpatient / ER
$2,493cash price (self-pay)
$3,116list price
$608–$2,894range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue Cross Blue Shield of Minnesota | PMAP | $608 |
| Blue Cross Blue Shield of Minnesota | Commercial | $1,216 |
| Sanford Health Plan Align | Medicare Replacement | $1,539 |
| Ucare | Medicare Replacement | $1,651 |
| Aetna | Medicare Replacement | $1,670 |
| Blue Cross Blue Shield of North Dakota | Medicare Replacement | $1,670 |
| Great Plains Medicare Advantage | Medicare Replacement | $1,670 |
| Health Partners | Medicare Replacement | $1,670 |
| United Healthcare | Medicare Replacement | $1,670 |
| Primewest | Medicare Replacement | $1,701 |
| Security Health Plan | Commercial | $1,714 |
| Blue Cross Blue Shield of North Dakota | Commercial | $2,112 |
| Health Partners | Commercial | $2,430 |
| Sanford Health Plan | Group Health/True/SD Exchange True | $2,460 |
| Medica | Choice | $2,571 |
| United Healthcare | Commercial | $2,602 |
| Aetna | Commercial | $2,708 |
| Ucare | Commercial | $2,738 |
| Medica | Elect | $2,748 |
| First Choice Health Network | Commercial | $2,804 |
| Healthez | Commercial | $2,804 |
| Multiplan | Commercial | $2,804 |
| Sanford Health Plan | Commercial/ND Pers/SD Exchange Commercial | $2,894 |
Inpatient
$2,493cash price (self-pay)
$3,116list price
$1,714–$2,894range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Security Health Plan | Commercial | $1,714 |
| Health Partners | Commercial | $2,430 |
| Sanford Health Plan | Group Health/True/SD Exchange True | $2,460 |
| Medica | Choice | $2,571 |
| United Healthcare | Commercial | $2,602 |
| Aetna | Commercial | $2,708 |
| Ucare | Commercial | $2,738 |
| Medica | Elect | $2,748 |
| First Choice Health Network | Commercial | $2,804 |
| Healthez | Commercial | $2,804 |
| Multiplan | Commercial | $2,804 |
| Sanford Health Plan | Commercial/ND Pers/SD Exchange Commercial | $2,894 |
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