CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Adventist Health Vallejo

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74177
Insurance Median: $4,062
Cash Discount Price: $1,268
vs. Medicare Baseline: 11.40x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Adventist Health Vallejo is $4,062. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,268. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 11.40x the Medicare baseline. Located in 525 Oregon St, Vallejo, CA.

Cash / Self-Pay

$1,268

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,062

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: $1,268 (356%)

Insurance Median: $4,062 (1140%)

Cash: $1,268 (356% of Medicare)

Ins. Median: $4,062 (1140% 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 1140% of the Medicare baseline (a markup of 1040%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

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

Billing Status

Remaining Deductible ($)

Your Coinsurance 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
Cigna	$48 - $8,558	13%
Blue Shield Mcr Adv	$85 - $357	24%
Medicare (plans)	$85 - $357	24%
Napa County Mcal Child	$85 - $357	24%
Tricare	$85 - $357	24%
Ah Employee Health Plan-All Plans	$93 - $643	26%
Interplan-All Plans	$102 - $5,450	29%
Kaiser-All Plans	$102 - $8,986	29%
Blue Shield Non-Epn-All Other Plans	$110 - $4,964	31%
UnitedHealthcare	$114 - $6,820	32%
Aetna	$118 - $1,646	33%
Western Growers-All Plans	$126 - $5,670	35%
Phcs-All Plans	$206 - $5,884	58%
Medi-Cal	$282 - $404	79%
Health Management Network-All Plans	$318 - $9,093	89%
Three Rivers-All Plans	$337 - $9,628	95%
Va Mcr-All Other Plans	$357	100%
Va Medi-Cal	$404	113%
Healthnet-All Plans	$1,060	297%
Blue Cross Blue Shield	$1,185 - $1,422	332%
Blue Shield Behav Hlth	$3,244 - $4,814	910%
Blue Shield Epn	$3,395 - $5,039	953%
Choicecare-All Plans	$5,046 - $7,489	1416%
Beech Street-All Plans	$5,406 - $8,024	1517%
Galaxy Network-All Plans	$6,487 - $9,628	1820%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $1,268.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 74177.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health Vallejo is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 74177.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.