CT abdomen and pelvis with contrast at Sanford Clear Lake Medical Center. CPT 74177.
What Sanford Clear Lake Medical Center publishes for this service, straight from its standard-charges file, last updated March 4, 2026.
Outpatient / ER
$4,703cash price (self-pay)
$5,879list price
$1,216–$5,467range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| 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 | $3,016 |
| Security Health Plan | Commercial | $3,233 |
| Ucare | Medicare Replacement | $3,239 |
| Wellmark SD | Medicare Replacement | $3,239 |
| Aetna | Medicare Replacement | $3,269 |
| Great Plains Medicare Advantage | Medicare Replacement | $3,269 |
| Health Partners | Medicare Replacement | $3,269 |
| United Healthcare | Medicare Replacement | $3,269 |
| Primewest | Medicare Replacement | $3,333 |
| Health Partners | State Employees | $3,804 |
| Sanford Health Plan | SD Exchange True | $4,075 |
| Health Partners | Commercial | $4,409 |
| Sanford Health Plan | Group Health/True | $4,647 |
| Sanford Health Plan | SD Exchange Commercial | $4,794 |
| Medica | Choice | $4,850 |
| United Healthcare | Commercial + Top 20 | $4,909 |
| Wellmark | PPO | $5,056 |
| Aetna | Commercial | $5,109 |
| Ucare | Commercial | $5,165 |
| Medica | Elect | $5,185 |
| Cigna | Commercial | $5,291 |
| First Choice Health Network | Commercial | $5,291 |
| Healthez | Commercial | $5,291 |
| Multiplan | Commercial | $5,291 |
| Sanford Health Plan | Commercial/ND Pers | $5,467 |
Inpatient
$4,703cash price (self-pay)
$5,879list price
$3,233–$5,467range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Security Health Plan | Commercial | $3,233 |
| Health Partners | State Employees | $3,804 |
| Sanford Health Plan | SD Exchange True | $4,075 |
| Health Partners | Commercial | $4,409 |
| Sanford Health Plan | Group Health/True | $4,647 |
| Sanford Health Plan | SD Exchange Commercial | $4,794 |
| Medica | Choice | $4,850 |
| United Healthcare | Commercial + Top 20 | $4,909 |
| Aetna | Commercial | $5,109 |
| Wellmark | PPO | $5,115 |
| Ucare | Commercial | $5,165 |
| Medica | Elect | $5,185 |
| Cigna | Commercial | $5,291 |
| First Choice Health Network | Commercial | $5,291 |
| Healthez | Commercial | $5,291 |
| Multiplan | Commercial | $5,291 |
| Sanford Health Plan | Commercial/ND Pers | $5,467 |
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