CT abdomen and pelvis with contrast at Lodi Memorial Hospital Association. CPT 74177.
What Lodi Memorial Hospital Association publishes for this service, straight from its standard-charges file, last updated August 2, 2026.
Outpatient / ER
$23.73cash price (self-pay)
$6,813list price
$47.70–$16,365range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Hp Healthy Kids Pro Fee | Hp Healthy Kids Pro Fee | $89.42 |
| Bc Mcal | Bc Mcal | $109 |
| Hp Mcal Pro Fee | Hp Mcal Pro Fee | $310 |
| Kaiser Mcal | Kaiser Mcal | $404 |
| Medi-Cal | Medi-Cal | $404 |
| Celtic Ins Company - All Plans | Celtic Ins Company - All Plans | $453 |
| Alignment Health Plan (Ahp)-All Plans | Alignment Health Plan (Ahp)-Al | $460 |
| Blue Shield Mcare Adv | Blue Shield Mcare Adv | $460 |
| Healthnet Mcare | Healthnet Mcare | $460 |
| Hp Of San Joaquin Mcr Adv | Hp Of San Joaquin Mcr Adv | $460 |
| Humana Mcr Adv - All Plans | Humana Mcr Adv - All Plans | $460 |
| Kaiser Mcr Adv | Kaiser Mcr Adv | $460 |
| Tricare Blue Shield - All Plans | Tricare Blue Shield - All Plans | $460 |
| UHC Mcr Adv | UHC Mcr Adv | $460 |
| Cca Health Plan Mcr Adv- All Plans | Cca Health Plan Mcr Adv- All Plan | $460 |
| Hp Of San Joaquin Mcal | Hp Of San Joaquin Mcal | $505 |
| Knnex Health - All Plans | Knnex Health - All Plans | $552 |
| Healthnet Mcal | Healthnet Mcal | $578 |
| UHC HMO | UHC HMO | $597 |
| UHC Jll | UHC Jll | $597 |
| Ah Employee Health Plan - All Plans | Ah Employee Health Plan - All Pl | $828 |
| Bright Health - All Plans | Bright Health - All Plans | $920 |
| Blue Cross Exchange | Blue Cross Exchange | $1,888 |
| Blue Cross Non-Mcs - All Other Plans | Blue Cross Non-Mcs - All Other | $2,098 |
| Blue Shield Epn - All Other Plans | Blue Shield Epn - All Other Plans | $2,207 |
| Blue Shield Non-Epn | Blue Shield Non-Epn | $2,289 |
| Kaiser Commercial - All Other Plans | Kaiser Commercial - All Other Pl | $2,793 |
| UHC All Payer - All Other Plans | UHC All Payer - All Other Plans | $2,828 |
| Aetna - All Plans | Aetna - All Plans | $3,000 |
| Healthnet- All Other Plans | Healthnet- All Other Plans | $3,346 |
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