CT abdomen and pelvis with contrast at Adventist Health Clearlake Hospital. CPT 74177.

What Adventist Health Clearlake Hospital publishes for this service, straight from its standard-charges file, last updated July 29, 2026.

Outpatient / ER

$2,793cash price (self-pay)

$7,757list price

$404–$12,870range insurers pay

Insurance plan	Negotiated rate
Bc Managed Mcal \| Bc Managed Mcal	$404
Medi-Cal \| Medi-Cal	$404
Blue Cross Exchange \| Blue Cross Exchange	$994
Blue Cross Non-Mcs \| Blue Cross Non-Mcs	$1,104
Blue Cross Mcs - All Other Plans \| Blue Cross Mcs - All Other Plans	$1,326
Kaiser Mcr Adv \| Kaiser Mcr Adv	$1,629
Blue Shield Mcr Adv \| Blue Shield Mcr Adv	$1,629
Tricare Blue Shield- All Plans \| Tricare Blue Shield- All Plans	$1,629
Blue Cross Mcr Adv \| Blue Cross Mcr Adv	$1,694
UHC Mcr Adv \| UHC Mcr Adv	$1,792
Blue Shield Epn - All Other Plans \| Blue Shield Epn - All Other Plans	$2,627
Blue Shield Non-Epn \| Blue Shield Non-Epn	$2,752
Ah Employee Health Plan - All Plans \| Ah Employee Health Plan - All Pl	$3,258
Aetna- All Plans \| Aetna- All Plans	$5,796
Western Growers- All Plans \| Western Growers- All Plans	$5,818
UHC Jll \| UHC Jll	$6,146
First Health- All Plans \| First Health- All Plans	$6,206
Healthnet- All Plans \| Healthnet- All Plans	$6,361
UHC All Payer - All Other Plans \| UHC All Payer - All Other Plans	$6,469
Foundation- All Plans \| Foundation- All Plans	$6,593
Humana- All Plans \| Humana- All Plans	$6,593
Phcs- All Plans \| Phcs- All Plans	$6,593
Health Mgmt Network- All Plans \| Health Mgmt Network- All Plans	$6,593
Interplan- All Plans \| Interplan- All Plans	$6,981
Kaiser- All Other Plans \| Kaiser- All Other Plans	$6,981
Cigna- All Plans \| Cigna- All Plans	$6,981
Three Rivers Provider Network- All Plans \| Three Rivers Provider Netwo	$6,981
Partnership Mcal - All Plans \| Partnership Mcal - All Plans	$12,799

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