CT abdomen and pelvis with contrast at Ukiah Adventist Hospital. CPT 74177.
What Ukiah Adventist Hospital publishes for this service, straight from its standard-charges file, last updated May 24, 2026.
Outpatient / ER
$67.80cash price (self-pay)
$339list price
$47.70–$6,728range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Cigna-All Plans | Cigna-All Plans | $47.70 |
| Blue Shield Mcr Adv | Blue Shield Mcr Adv | $85.16 |
| Kaiser Mcr Adv | Kaiser Mcr Adv | $85.16 |
| Tricare Blue Shield-All Plans | Tricare Blue Shield-All Plans | $85.16 |
| Ah Employee Health Plan - All Plans | Ah Employee Health Plan - All Pl | $93.68 |
| UHC Jll Csp 1/1/25 | UHC Jll Csp 1/1/25 | $114 |
| Healthnet-All Plans | Healthnet-All Plans | $124 |
| Western Growers-All Plans | Western Growers-All Plans | $126 |
| Blue Shield Epn-All Other Plans | Blue Shield Epn-All Other Plans | $157 |
| Blue Shield Non-Epn | Blue Shield Non-Epn | $166 |
| Mendocino Lcc District-All Plans | Mendocino Lcc District-All Plans | $220 |
| Aetna-All Plans | Aetna-All Plans | $230 |
| Kaiser-All Other Plans | Kaiser-All Other Plans | $271 |
| Medi-Cal | Medi-Cal | $282 |
| Kaiser Medi-Cal | Kaiser Medi-Cal | $282 |
| Three Rivers-All Plans | Three Rivers-All Plans | $305 |
| UHC All Payer-All Other Plans | UHC All Payer-All Other Plans | $420 |
| UHC Mcr Adv | UHC Mcr Adv | $481 |
| Blue Cross Exchange | Blue Cross Exchange | $1,088 |
| Blue Cross Non-Mcs | Blue Cross Non-Mcs | $1,209 |
| Blue Cross Mcs-All Other Plans | Blue Cross Mcs-All Other Plans | $1,451 |
| Foundation For Medical Care-All Plans | Foundation For Medical Care-Al | $5,606 |
| Phcs Multiplan-All Plans | Phcs Multiplan-All Plans | $5,980 |
| Networks By Design-All Plans | Networks By Design-All Plans | $5,980 |
| Interplan-All Plans | Interplan-All Plans | $6,130 |
| Beech Street-All Plans | Beech Street-All Plans | $6,354 |
| Choice Care-All Plans | Choice Care-All Plans | $6,354 |
| Health Mgmt Network-All Plans | Health Mgmt Network-All Plans | $6,354 |
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