CT abdomen and pelvis with contrast at Henry Ford St John Hospital. CPT 74177.
What Henry Ford St John Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$1,683cash price (self-pay)
$3,005list price
$183–$3,005range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Meridian Health Plan | 1945_medicaid Replacement Meridian Health Outpa | $183 |
| Ahlic | 2163_ahlic 20241001 | $241 |
| Hap HMO | 2166_health Alliance HMO 20241001 | $241 |
| Hap HMO | 2174_sjma Health Alliance HMO 20241001 | $241 |
| Hap Preferred | 2171_hap Preferred (Php) 20241001 | $241 |
| Priority HMO | 2010_priority HMO 20210701 | $258 |
| Blue Cross PPO | 2059_sjmc Blue Cross Blue Shield PPO 20220401 | $332 |
| Blue Cross Traditional | 2058_sjmc Blue Cross Blue Shield Of Michigan | $332 |
| Tricare | 2211_tricare Op 20250101 | $350 |
| Meridian Wellcare | 2210_medicare Advantage Meridian Wellcare Outpatie | $367 |
| Phcs POS | 1311_phcs POS 20201001 | $829 |
| Phcs PPO | 1457_phcs PPO 20201001 | $829 |
| Ppom | 934_ppom 20191001 | $3,005 |
Inpatient
—cash price (self-pay)
—list price
$332–$665range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medicare Pace | 2278_sjmc Sjma Pace Medicare Inpatient 20251001 | $332 |
| Amerihealth Vip Care | 2273_medicare Advantage Amerihealth Vip Care In | $346 |
| Aetna Better Health | 2272_medicare Advantage Aetna Better Health Inpa | $350 |
| Harbor Advantage HMO | 2274_medicare Advantage Harbor Advantage HMO In | $350 |
| Medicare Replacement | 2279_medicare Advantage Blue Cross Network Conn | $350 |
| Tricare | 480_tricare Ip 20170101 | $350 |
| Veterans Choice | 2283_veterans Choice Ip 20251001 | $350 |
| Humana Mcr | 2275_medicare Advantage Humana Inpatient 20251001 | $353 |
| Mclaren Medicare Advantage HMO | 2276_medicare Advantage Mclaren Inpat | $367 |
| Meridian Wellcare | 2280_medicare Advantage Meridian Wellcare Inpatien | $367 |
| Molina Advantage | 2281_medicare Advantage Molina Inpatient 20251001 | $367 |
| Molina Health Link | 2282_medicare Advantage Molina Health Link Inpati | $367 |
| Meridian Ambetter | 2286_medicare Advantage Meridian Ambetter Inpatien | $437 |
| Molina Market Place | 2287_molina Marketplace Inpatient 20251001 | $437 |
| Smarthealth | 2284_smarthealth Inpatient 20251001 | $490 |
| Aaa-Auto Insurance | 2285_aaa-Auto Insurance Inpatient 20251001 | $665 |
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