CT abdomen and pelvis with contrast at Henry Ford Providence Novi Hospital. CPT 74177.
What Henry Ford Providence Novi Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$1,784cash price (self-pay)
$3,186list price
$183–$722range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Jvhl - Medicaid Replacement | 1245_sjpk,Sjpr Medicaid Replacement HMO | $183 |
| Molina Health | 1081_sjpk,Sjpr Medicaid Replacement Molina Health Inpa | $183 |
| Health Plan Of Mi Medicaid HMO | 1083_sjpk,Sjpr Meridian Health Inpati | $183 |
| Jvhl - Medicaid Replacement | 1079_sjpk,Sjpr Medicaid HMO Jvhl Inpatie | $183 |
| Blue Caid Michigan | 1266_sjpk,Sjpr Medicaid Replacement Blue Caid Of | $203 |
| Great Lakes- UHC Community Plan | 1247_sjpk,Sjpr Medicaid Replacement | $203 |
| Harbor Health Mcd | 1240_sjpk Medicaid Repleacement Harbor Health Outp | $203 |
| Health Plan Of Mi Medicaid HMO | 1262_sjpk,Sjpr Medicaid Replacement M | $203 |
| Medicaid | 1263_sjpk,Sjpr Mi Medicaid Outpatient 20250101 | $203 |
| Medicaid Replacement | 1241_sjpk Medicaid HMO Outpatient 20250101 | $203 |
| Molina Health | 1264_sjpk,Sjpr Medicaid Replacement Molina Health Outp | $203 |
| Omnicare Medicaid HMO | 1239_sjpk Medicaid Repleacement Omnicare Outpa | $203 |
| Total Health Care | 1246_sjpk,Sjpr Medicaid Replacement Total Health C | $203 |
| Priority PPO | 1105_sjpk,Sjpr Priority PPO 20210801 | $221 |
| Hap Alliance Health | 1212_sjpk,Sjpr Ahlic 20241001 | $241 |
| Hap HMO POS | 1217_sjpk,Sjpr Hap HMO 20241001 | $241 |
| Priority Health HMO | 1104_sjpk,Sjpr Priority HMO 20210701 | $258 |
| Hap Preferred | 1210_sjpk,Sjpr Hap Preferred 20241001 | $284 |
| Amerihealth Vip Care Mcr | 1254_sjpk,Sjpr Medicare Advantage Ameriheal | $301 |
| Aetna Medicare | 1255_sjpk,Sjpr Medicare Advantage Aetna Outpatient 20 | $350 |
| Auto Insurance | 1257_sjpk,Sjpr Auto Insurance Outpatient 20250101 | $350 |
| Jvhl - Mcr Replacement | 1251_sjpk,Sjpr Medicare Advantage Jvhl Outpat | $350 |
| Mcr Replacement | 1253_sjpk,Sjpr Medicare Advantage HMO Outpatient 202 | $350 |
| Humana Mcr | 1252_sjpk,Sjpr Medicare Advantage Humana Outpatient 20250 | $353 |
| Meridian Wellcare | 1250_sjpk,Sjpr Medicare Advantage Meridian Wellcar | $367 |
| Molina Advantage | 1249_sjpk,Sjpr Medicare Advantage Molina Outpatient | $367 |
| Bc Metro Detroit HMO | 1141_sjpk Blue Cross Blue Shield Metro Detroit | $369 |
| Meridian Ambetter | 1258_sjpk,Sjpr Meridian Ambetter Outpatient 202501 | $437 |
| Molina Marketplace | 1259_sjpk,Sjpr Molina Marketplace Outpatient 2025 | $437 |
| Bc Metro Detroit EPO | 1139_sjpk Blue Cross Blue Shield Metro Detroit | $477 |
Inpatient
—cash price (self-pay)
—list price
$203–$483range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Amerihealth Vip Care Mcr | 1174_sjpk,Sjpr Medicare Advantage Ameriheal | $346 |
| Aetna Medicare | 1171_sjpk,Sjpr Medicare Advantage Aetna Inpatient 202 | $350 |
| Auto Insurance | 1219_sjpk,Sjpr Auto Insurance Inpatient 20241001 | $350 |
| Health Plan Of Mi Medicaid HMO | 1083_sjpk,Sjpr Meridian Health Inpati | $350 |
| Jvhl - Mcr Replacement | 1180_sjpk,Sjpr Medicare Advantage Jvhl Inpati | $350 |
| Jvhl - Medicaid Replacement | 1079_sjpk,Sjpr Medicaid HMO Jvhl Inpatie | $350 |
| Mcr Replacement | 1183_sjpk,Sjpr Medicare Advantage HMO Inpatient 2024 | $350 |
| Veterans Choice | 1230_va Optum Health Inpatient 20241001 | $350 |
| Humana Mcr | 1177_sjpk,Sjpr Medicare Advantage Humana Inpatient 202410 | $353 |
| Meridian Wellcare | 1189_sjpk,Sjpr Medicare Advantage Meridian Wellcar | $367 |
| Molina Advantage | 1192_sjpk,Sjpr Medicare Advantage Molina Inpatient | $367 |
| Meridian Ambetter | 1221_sjpk,Sjpr Meridian Ambetter Inpatient 2024100 | $437 |
| Molina Marketplace | 1223_sjpk,Sjpr Molina Marketplace Inpatient 20241 | $437 |
| Smart Health | 1227_sjpk,Sjpr Smart Health Inpatient 20241001 | $483 |
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