CMS Price Transparency Data

CT scan, chest (no contrast)

Facility: Adventist Health Clearlake

Billing Code: 71250 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 71250
Insurance Median: $2,939
Cash Discount Price: $1,453
vs. Medicare Baseline: 27.52x Medicare

The contracted insurance negotiated median rate for a CT scan, chest (no contrast) at Adventist Health Clearlake is $2,939. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,453. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 27.52x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$1,453

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,939

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: $1,453 (1360%)

Insurance Median: $2,939 (2752%)

Cash: $1,453 (1360% of Medicare)

Ins. Median: $2,939 (2752% 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 2752% of the Medicare baseline (a markup of 2652%). 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
Bc Managed Mcal	$233	218%
Medi-Cal	$233	218%
Blue Shield Mcr Adv	$740 - $955	693%
Kaiser Mcr Adv	$740 - $955	693%
Tricare	$740 - $955	693%
Blue Cross Blue Shield	$770 - $1,166	721%
UnitedHealthcare	$814 - $3,793	762%
Ah Employee Health Plan - All Plans	$1,480 - $1,910	1386%
Blue Shield Epn - All Other Plans	$2,185	2046%
Blue Shield Non-Epn	$2,288	2142%
Aetna	$2,633 - $3,398	2465%
Western Growers- All Plans	$2,643 - $3,411	2474%
First Health- All Plans	$2,819 - $3,638	2639%
Healthnet- All Plans	$2,890 - $3,729	2706%
Foundation- All Plans	$2,995 - $3,866	2804%
Health Mgmt Network- All Plans	$2,995 - $3,866	2804%
Humana	$2,995 - $3,866	2804%
Phcs- All Plans	$2,995 - $3,866	2804%
Cigna	$3,172 - $4,093	2970%
Interplan- All Plans	$3,172 - $4,093	2970%
Kaiser- All Other Plans	$3,172 - $4,093	2970%
Three Rivers Provider Network- All Plans	$3,172 - $4,093	2970%
Partnership Mcal - All Plans	$5,815 - $7,504	5444%

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 $1,453.
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 Clearlake 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.