CMS Price Transparency Data

CT scan, pelvis

Facility: Adventist Health Clearlake

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $3,745
Cash Discount Price: $1,736
vs. Medicare Baseline: 35.06x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Adventist Health Clearlake is $3,745. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,736. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 35.06x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$1,736

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,745

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: $1,736 (1625%)

Insurance Median: $3,745 (3506%)

Cash: $1,736 (1625% of Medicare)

Ins. Median: $3,745 (3506% 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 3506% of the Medicare baseline (a markup of 3406%). 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	$205	192%
Medi-Cal	$205	192%
Blue Cross Blue Shield	$873 - $1,165	817%
Blue Shield Mcr Adv	$943 - $1,082	883%
Kaiser Mcr Adv	$943 - $1,082	883%
Tricare	$943 - $1,082	883%
UnitedHealthcare	$1,037 - $4,298	971%
Ah Employee Health Plan - All Plans	$1,886 - $2,165	1766%
Blue Shield Epn - All Other Plans	$2,185	2046%
Blue Shield Non-Epn	$2,288	2142%
Aetna	$3,356 - $3,851	3142%
Western Growers- All Plans	$3,368 - $3,866	3153%
First Health- All Plans	$3,593 - $4,123	3364%
Healthnet- All Plans	$3,683 - $4,226	3448%
Foundation- All Plans	$3,817 - $4,381	3574%
Health Mgmt Network- All Plans	$3,817 - $4,381	3574%
Humana	$3,817 - $4,381	3574%
Phcs- All Plans	$3,817 - $4,381	3574%
Cigna	$4,042 - $4,639	3784%
Interplan- All Plans	$4,042 - $4,639	3784%
Kaiser- All Other Plans	$4,042 - $4,639	3784%
Three Rivers Provider Network- All Plans	$4,042 - $4,639	3784%
Partnership Mcal - All Plans	$7,410 - $8,504	6938%

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 $1,736.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72192.

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 72192.
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.