CMS Price Transparency Data

CT scan, neck (cervical spine)

Facility: Adventist Health Clearlake

Billing Code: 72125 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72125
  • Insurance Median: $3,753
  • Cash Discount Price: $1,990
  • vs. Medicare Baseline: 35.14x Medicare
The contracted insurance negotiated median rate for a CT scan, neck (cervical spine) at Adventist Health Clearlake is $3,753. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,990. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 35.14x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.
Cash / Self-Pay
$1,990

Average discount available for prompt cash payment at this facility.

Insurance Median
$3,753

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: $1,990 (1863%)
Insurance Median: $3,753 (3514%)
Cash: $1,990 (1863% of Medicare)
Ins. Median: $3,753 (3514% 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 3514% of the Medicare baseline (a markup of 3414%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 $239 224%
Medi-Cal $239 224%
Blue Cross Blue Shield $874 - $1,431 818%
Blue Shield Mcr Adv $945 - $1,376 885%
Kaiser Mcr Adv $945 - $1,376 885%
Tricare $945 - $1,376 885%
UnitedHealthcare $1,040 - $5,465 974%
Ah Employee Health Plan - All Plans $1,890 - $2,752 1769%
Blue Shield Epn - All Other Plans $2,185 2046%
Blue Shield Non-Epn $2,288 2142%
Aetna $3,362 - $4,896 3148%
Western Growers- All Plans $3,375 - $4,915 3160%
First Health- All Plans $3,600 - $5,242 3370%
Healthnet- All Plans $3,690 - $5,373 3455%
Foundation- All Plans $3,825 - $5,570 3581%
Health Mgmt Network- All Plans $3,825 - $5,570 3581%
Humana $3,825 - $5,570 3581%
Phcs- All Plans $3,825 - $5,570 3581%
Cigna $4,050 - $5,898 3792%
Interplan- All Plans $4,050 - $5,898 3792%
Kaiser- All Other Plans $4,050 - $5,898 3792%
Three Rivers Provider Network- All Plans $4,050 - $5,898 3792%
Partnership Mcal - All Plans $7,425 - $10,812 6952%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 15630 18Th Ave - Hwy 53, Clearlake, CA 95422
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals