CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Adventist Health Clearlake

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 74177
  • Insurance Median: $6,180
  • Cash Discount Price: $2,800
  • vs. Medicare Baseline: 17.34x Medicare
The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Adventist Health Clearlake is $6,180. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,800. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 17.34x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.
Cash / Self-Pay
$2,800

Average discount available for prompt cash payment at this facility.

Insurance Median
$6,180

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$356.43

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $356.43 (100%)
Cash / Self-Pay: $2,800 (786%)
Insurance Median: $6,180 (1734%)
Cash: $2,800 (786% of Medicare)
Ins. Median: $6,180 (1734% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $356.43 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 1734% of the Medicare baseline (a markup of 1634%). 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 $404 113%
Medi-Cal $404 113%
Blue Cross Blue Shield $994 - $1,704 279%
Blue Shield Mcr Adv $1,629 - $1,638 457%
Kaiser Mcr Adv $1,629 - $1,638 457%
Tricare $1,629 - $1,638 457%
UnitedHealthcare $1,792 - $6,505 503%
Blue Shield Epn - All Other Plans $2,627 737%
Blue Shield Non-Epn $2,752 772%
Ah Employee Health Plan - All Plans $3,258 - $3,276 914%
Aetna $5,796 - $5,828 1626%
Western Growers- All Plans $5,818 - $5,850 1632%
First Health- All Plans $6,206 - $6,240 1741%
Healthnet- All Plans $6,361 - $6,396 1785%
Foundation- All Plans $6,593 - $6,630 1850%
Health Mgmt Network- All Plans $6,593 - $6,630 1850%
Humana $6,593 - $6,630 1850%
Phcs- All Plans $6,593 - $6,630 1850%
Cigna $6,981 - $7,020 1959%
Interplan- All Plans $6,981 - $7,020 1959%
Kaiser- All Other Plans $6,981 - $7,020 1959%
Three Rivers Provider Network- All Plans $6,981 - $7,020 1959%
Partnership Mcal - All Plans $12,799 - $12,870 3591%

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