CMS Price Transparency Data

Review of medical records for care

Facility: Adventist Health Ukiah Valley

Billing Code: 90889 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90889
Insurance Median: $93
Cash Discount Price: $25
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Review of medical records for care at Adventist Health Ukiah Valley is $93. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $25. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 275 Hospital Drive, Ukiah, CA.

Cash / Self-Pay

$25

Average discount available for prompt cash payment at this facility.

Insurance Median

$93

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

N/A

Standard federal government reimbursement rate for this code.

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
Blue Cross Blue Shield	$66	N/A
Aetna	$79	N/A
Mendocino Lcc District-All Plans	$80	N/A
Ah Employee Health Plan - All Plans	$86	N/A
Cigna	$90	N/A
UnitedHealthcare	$90 - $93	N/A
Kaiser-All Other Plans	$98	N/A
Western Growers-All Plans	$98	N/A
Three Rivers-All Plans	$111	N/A
Kaiser Medi-Cal	$123	N/A
Medi-Cal	$123	N/A
Blue Shield Epn-All Other Plans	$152	N/A
Blue Shield Non-Epn	$161	N/A

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 $25.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 90889.

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 90889.
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.