CT abdomen and pelvis with contrast at Aspirus Keweenaw Hospital. CPT 74177.
What Aspirus Keweenaw Hospital publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$584cash price (self-pay)
$4,936list price
$54.95–$853range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Upper Pennisula Health Plan | Michigan Medicaid | $54.95 |
| Tricare East | Tricare Plans | $61.58 |
| Tricare West | Tricare Plans | $61.58 |
| United Healthcare Of Wisconsin, Inc. | United Healthcare Medicare Adva | $80.35 |
| Aetna | Medicare Advantage Esa | $80.47 |
| Blue Cross Blue Shield Of Michigan | Blue Care Network Medicare Advant | $80.47 |
| Humana | Humana Medicare Ppo/Pos/Hmo Network Plans | $80.47 |
| Forest County Potowatomi | Forest County Potowatomi Self-Funded Ppo Pl | $82.11 |
| United Healthcare Of Wisconsin, Inc. | Va Community Care Network | $82.11 |
| Blue Cross Blue Shield Of Michigan | Blue Care Network | $170 |
| Blue Cross Blue Shield Of Michigan | Blue Cross Blue Shield Of Michiga | $176 |
| Aspirus Health Plan, Inc. | Aspirus Health Plan Hmo/Pos | $461 |
| United Healthcare Of Wisconsin, Inc. | United Healthcare Hmo/Ppo/Pos/E | $630 |
| Cofinity Preferred Provider Of Michigan Insurance Company | Cofinity C | $718 |
| Aetna | Commercial & Aetna Funding Advantage Plans | $805 |
| Cigna | Cigna Ppo And Open Access Plus Benefit Plans | $853 |
Billed more than this?
Scan my billSnap a photo of your bill. We compare every line with these prices and coding rules, free.