CMS Price Transparency Data

CT scan, sinuses

Facility: Adventist Health Clearlake

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $3,225
Cash Discount Price: $1,578
vs. Medicare Baseline: 30.19x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Adventist Health Clearlake is $3,225. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,578. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 30.19x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$1,578

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,225

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: $1,578 (1477%)

Insurance Median: $3,225 (3019%)

Cash: $1,578 (1477% of Medicare)

Ins. Median: $3,225 (3019% 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 3019% of the Medicare baseline (a markup of 2919%). 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	$209	196%
Medi-Cal	$209	196%
Blue Cross Blue Shield	$700 - $1,070	655%
Blue Shield Mcr Adv	$812 - $1,029	760%
Kaiser Mcr Adv	$812 - $1,029	760%
Tricare	$812 - $1,029	760%
UnitedHealthcare	$893 - $4,085	836%
Ah Employee Health Plan - All Plans	$1,624 - $2,057	1520%
Blue Shield Epn - All Other Plans	$1,747	1636%
Blue Shield Non-Epn	$1,830	1713%
Aetna	$2,889 - $3,660	2705%
Western Growers- All Plans	$2,900 - $3,674	2715%
First Health- All Plans	$3,094 - $3,918	2897%
Healthnet- All Plans	$3,171 - $4,016	2969%
Foundation- All Plans	$3,287 - $4,163	3077%
Health Mgmt Network- All Plans	$3,287 - $4,163	3077%
Humana	$3,287 - $4,163	3077%
Phcs- All Plans	$3,287 - $4,163	3077%
Cigna	$3,480 - $4,408	3258%
Interplan- All Plans	$3,480 - $4,408	3258%
Kaiser- All Other Plans	$3,480 - $4,408	3258%
Three Rivers Provider Network- All Plans	$3,480 - $4,408	3258%
Partnership Mcal - All Plans	$6,381 - $8,082	5974%

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 $1,578.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70486.

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 70486.
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.