CMS Price Transparency Data

CT scan, abdomen and pelvis (no contrast)

Facility: Adventist Health Clearlake

Billing Code: 74176 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 74176
  • Insurance Median: $5,214
  • Cash Discount Price: $2,361
  • vs. Medicare Baseline: 21.39x Medicare
The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (no contrast) at Adventist Health Clearlake is $5,214. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,361. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 21.39x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.
Cash / Self-Pay
$2,361

Average discount available for prompt cash payment at this facility.

Insurance Median
$5,214

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)
Cash / Self-Pay: $2,361 (969%)
Insurance Median: $5,214 (2139%)
Cash: $2,361 (969% of Medicare)
Ins. Median: $5,214 (2139% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 2139% of the Medicare baseline (a markup of 2039%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group Contract Rate Range vs. Medicare Reference
Bc Managed Mcal $257 105%
Medi-Cal $257 105%
Blue Cross Blue Shield $521 - $1,441 214%
Blue Shield Mcr Adv $1,369 - $1,386 562%
Kaiser Mcr Adv $1,369 - $1,386 562%
Tricare $1,369 - $1,386 562%
Blue Shield Epn - All Other Plans $1,377 565%
Blue Shield Non-Epn $1,442 592%
UnitedHealthcare $1,506 - $5,504 618%
Ah Employee Health Plan - All Plans $2,738 - $2,772 1123%
Aetna $4,870 - $4,932 1998%
Western Growers- All Plans $4,888 - $4,950 2005%
First Health- All Plans $5,214 - $5,280 2139%
Healthnet- All Plans $5,345 - $5,412 2193%
Foundation- All Plans $5,540 - $5,610 2273%
Health Mgmt Network- All Plans $5,540 - $5,610 2273%
Humana $5,540 - $5,610 2273%
Phcs- All Plans $5,540 - $5,610 2273%
Cigna $5,866 - $5,940 2406%
Interplan- All Plans $5,866 - $5,940 2406%
Kaiser- All Other Plans $5,866 - $5,940 2406%
Three Rivers Provider Network- All Plans $5,866 - $5,940 2406%
Partnership Mcal - All Plans $10,755 - $10,890 4412%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 15630 18Th Ave - Hwy 53, Clearlake, CA 95422
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals