CMS Price Transparency Data

CT scan, chest (no contrast)

Facility: Adventist Health Ukiah Valley

Billing Code: 71250 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 71250
Insurance Median: $233
Cash Discount Price: $456
vs. Medicare Baseline: 2.18x Medicare

The contracted insurance negotiated median rate for a CT scan, chest (no contrast) at Adventist Health Ukiah Valley is $233. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $456. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.18x the Medicare baseline. Located in 275 Hospital Drive, Ukiah, CA.

Cash / Self-Pay

$456

Average discount available for prompt cash payment at this facility.

Insurance Median

$233

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $456 (427%)

Insurance Median: $233 (218%)

Cash: $456 (427% of Medicare)

Ins. Median: $233 (218% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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 218% of the Medicare baseline (a markup of 118%). 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	$30 - $3,398	28%
Blue Shield Mcr Adv	$50 - $144	47%
Kaiser Mcr Adv	$50 - $144	47%
Tricare	$50 - $144	47%
Ah Employee Health Plan - All Plans	$55 - $259	51%
UnitedHealthcare	$72 - $3,642	67%
Healthnet-All Plans	$73 - $2,492	68%
Western Growers-All Plans	$74 - $1,830	69%
Blue Shield Epn-All Other Plans	$88 - $1,460	82%
Blue Shield Non-Epn	$93 - $1,499	87%
Kaiser Medi-Cal	$127 - $233	119%
Medi-Cal	$127 - $233	119%
Mendocino Lcc District-All Plans	$130 - $2,832	122%
Kaiser-All Other Plans	$160 - $3,486	150%
Aetna	$178 - $1,160	167%
Three Rivers-All Plans	$180 - $3,921	169%
Blue Cross Blue Shield	$957 - $1,276	896%
Foundation For Medical Care-All Plans	$3,268	3060%
Networks By Design-All Plans	$3,486	3264%
Phcs Multiplan-All Plans	$3,486	3264%
Interplan-All Plans	$3,573	3345%
Beech Street-All Plans	$3,703	3467%
Choice Care-All Plans	$3,703	3467%
Health Mgmt Network-All Plans	$3,703	3467%

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 $456.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 71250.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health Ukiah Valley is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 71250.
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.