CT abdomen and pelvis with contrast at Henry Ford Jackson Hospital. CPT 74177.
What Henry Ford Jackson Hospital publishes for this service, straight from its standard-charges file, last updated June 28, 2026.
Outpatient / ER
$114cash price (self-pay)
$530list price
$53.46–$3,962range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Humana Military | Tricare | $185 |
| Blue Cross | Blue Cross Complete | $186 |
| HAP | HAP Caresource Medicaid | $186 |
| McLaren | Medicaid HMO | $186 |
| Meridian | Medicaid HMO | $186 |
| Priority Health | Medicaid HMO | $186 |
| Aetna Better Health | Medicaid HMO | $196 |
| Molina | Medicaid HMO | $197 |
| HAP | Commercial | $211 |
| Veterans Evaluation Services | All Products | $337 |
| Aetna | Medicare Advantage | $349 |
| Blue Cross | Medicare Plus Blue | $349 |
| Blue Cross | BCN Advantage | $349 |
| Cascade Thome Pace | All Products | $349 |
| Humana | Medicare Advantage | $349 |
| McLaren | Medicare Advantage | $349 |
| Molina | Dual MI Coordinated Health | $349 |
| Priority Health | Dual Premier_HIDE-SNP | $349 |
| Priority Health | Medicare Advantage | $349 |
| United Healthcare | VACCN | $349 |
| WellCare | Wellcare Meridian Dual Align (HMO D-SNP) | $349 |
| HAP | HAP Dual Products | $353 |
| HAP | Medicare Advantage | $353 |
| Meridian | Ambetter From Meridian | $384 |
| Blue Cross | BCBSM Commercial | $393 |
| HAP | Henry Ford Select -HPN commercial | $419 |
| Nomi | All Products | $424 |
| Bcn | HMO | $650 |
| Blue Cross | BCN Commercial | $650 |
| Vitalcore | All Products | $803 |
Inpatient
—cash price (self-pay)
$4,402list price
$2,211–$3,962range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| United Healthcare | UHC Commercial | $3,244 |
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