CT abdomen and pelvis with contrast at Henry Ford Wyandotte Hospital:. CPT 74177.
What Henry Ford Wyandotte Hospital: publishes for this service, straight from its standard-charges file, last updated June 28, 2026.
Outpatient / ER
$118cash price (self-pay)
$530list price
$53.46–$2,699range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| ScriptGuideRX | All Products | $106 |
| Blue Cross | GM Connected Care | $124 |
| HAP | HAP Caresource Medicaid | $186 |
| McLaren | Medicaid HMO | $186 |
| Meridian | Medicaid HMO | $186 |
| Priority Health | Medicaid HMO | $186 |
| Aetna Better Health | Medicaid HMO | $190 |
| Humana Military | Tricare | $194 |
| Molina | Medicaid HMO | $196 |
| HAP | HAP HMO_AHL_Fully Insured | $324 |
| Pace SE MI | Medicare Advantage | $330 |
| Blue Cross | BCBSM Commercial | $338 |
| Amerihealth Caritas | Dual Products | $341 |
| Aetna | Medicare Advantage | $348 |
| Blue Cross | BCN Advantage | $348 |
| Blue Cross | Medicare Plus Blue | $348 |
| HAP | Medicare Advantage | $348 |
| HAP | HAP Dual Products | $348 |
| McLaren | Medicare Advantage | $348 |
| Molina | Dual MI Coordinated Health | $348 |
| Priority Health | Dual Premier_HIDE-SNP | $348 |
| Priority Health | Medicare Advantage | $348 |
| Trinity Health Plan | Medicare Advantage | $348 |
| United Healthcare | Erickson Advantage | $348 |
| Humana | Medicare Advantage | $351 |
| HAP | Self-Funded | $368 |
| Nomi | All Products | $370 |
| Aetna | Dual Products | $382 |
| HAP | Henry Ford Select -HPN commercial | $417 |
| Meridian | Ambetter From Meridian | $469 |
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