CT abdomen and pelvis with contrast at lodi hospital. CPT 74177.
What lodi hospital publishes for this service, straight from its standard-charges file, last updated June 15, 2026.
Outpatient / ER
$1,602cash price (self-pay)
$2,464list price
$356–$2,464range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem | Medicare Advantage | $356 |
| OPTUM | All Products VA | $357 |
| OPTUM | Medicare Advantage Transplant | $357 |
| OPTUM | Managed Medicaid Transplant | $524 |
| Buckeye | Managed Medicaid | $552 |
| CARESOURCE | Managed Medicaid | $552 |
| ANTHEM | Managed Medicaid | $580 |
| MOLINA | Managed Medicaid | $580 |
| AMERIHEALTH | Managed Medicaid | $607 |
| Oscar | All Products | $697 |
| HUMANA | Medicare Advantage HMO | $739 |
| MMO | Medicare Advantage HMO & PPO | $739 |
| Aetna | Medicare Advantage | $788 |
| Php | All Products | $788 |
| Phphi | All Products | $788 |
| Amish Community Aid Plan | ALL PRODUCTS | $1,109 |
| Aultcare | PPO/HMO | $1,185 |
| Ohcp | All Products | $1,198 |
| Omas | All Products | $1,232 |
| Mmo | Traditional | $1,284 |
| Ohio Healthy | TRANSPLANT | $1,331 |
| OPTUM | All Products Transplant | $1,395 |
| AETNA | Acop | $1,400 |
| Summacare | Preferred | $1,419 |
| Anthem | Hpn | $1,492 |
| Summacare | PREMIER | $1,542 |
| Cigna | All Products | $1,565 |
| Anthem | Traditional | $1,632 |
| Cc Ehp | All Products | $1,656 |
| AETNA | Asa_Whirlpool_Peia | $1,693 |
Inpatient
$1,602cash price (self-pay)
$2,464list price
$697–$2,464range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Oscar | All Products | $889 |
| Amish Community Aid Plan | ALL PRODUCTS | $1,232 |
| Anthem | Hpn | $1,345 |
| Anthem | PPO/HMO | $1,583 |
| Anthem | Traditional | $1,665 |
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