CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Essentia Health Holy Trinity Hospital

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 74177
  • Insurance Median: $2,251
  • Cash Discount Price: $2,528
  • vs. Medicare Baseline: 6.32x Medicare
The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Essentia Health Holy Trinity Hospital is $2,251. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,528. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 6.32x the Medicare baseline. Located in 115 Second Street West, Box 157, Graceville, MN.
Cash / Self-Pay
$2,528

Average discount available for prompt cash payment at this facility.

Insurance Median
$2,251

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$356.43

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $356.43 (100%)
Cash / Self-Pay: $2,528 (709%)
Insurance Median: $2,251 (632%)
Cash: $2,528 (709% of Medicare)
Ins. Median: $2,251 (632% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $356.43 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 632% of the Medicare baseline (a markup of 532%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group Contract Rate Range vs. Medicare Reference
Itasca Med Care $357 100%
Primewest $371 104%
Healthpartners Care Pmap $1,331 373%
Medica Access $1,362 - $2,131 382%
Sanford Healthplan $1,467 - $1,545 412%
Blue Cross Blue Shield $1,830 - $2,982 513%
Blue Plus Pmap Pcc Prime $1,882 - $2,981 528%
Healthpartners $2,080 - $2,275 584%
Advocare/Security Health $2,121 595%
Freedom Blue Ppo $2,121 595%
Healthpartners Care Msho / Mcr Adv $2,121 595%
Imcare Msho Pcc Prime $2,121 595%
Imcare Msho Ref Req $2,121 595%
Medica Advantage Solutions $2,121 595%
Medica Msho/Dual Solutions $2,121 595%
Medica Prime Solution Group $2,121 595%
Medicare (plans) $2,121 595%
Nd Va Administration $2,121 595%
Platinum Blue/Vantage Blue $2,121 595%
Primewest Msho $2,121 595%
Secure Blue Msho $2,121 595%
Ubh Cost Plan $2,121 595%
Ubh Msho $2,121 595%
Ucare Msho $2,121 595%
UnitedHealthcare $2,121 - $3,096 595%
Ucare $2,251 632%
Cigna $2,275 638%
Healthpartners Pcc Prime $2,275 638%
Wea $2,463 - $2,634 691%
America'S Ppo $2,651 744%
Wps $2,839 - $2,874 797%
Medica $2,843 - $2,993 798%
Medica Uplan $2,843 798%
Aetna $2,908 816%
Medica Choice $3,082 865%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 115 Second Street West, Box 157, Graceville, MN 56240
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals