CMS Price Transparency Data

Culture, bacterial

Facility: Adventist Health Clearlake

Billing Code: 87070 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87070
Insurance Median: $83
Cash Discount Price: $86
vs. Medicare Baseline: 9.63x Medicare

The contracted insurance negotiated median rate for a Culture, bacterial at Adventist Health Clearlake is $83. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $86. Compared to the federal Medicare reimbursement reference rate of $8.62, this hospital’s rate is 9.63x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$86

Average discount available for prompt cash payment at this facility.

Insurance Median

$83

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$8.62

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $8.62 (100%)

Cash / Self-Pay: $86 (998%)

Insurance Median: $83 (963%)

Cash: $86 (998% of Medicare)

Ins. Median: $83 (963% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $8.62 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 963% of the Medicare baseline (a markup of 863%). 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
Blue Cross Blue Shield	$2 - $101	23%
Blue Shield Mcr Adv	$2 - $83	23%
Kaiser Mcr Adv	$2 - $83	23%
Tricare	$2 - $83	23%
Ah Employee Health Plan - All Plans	$3 - $166	35%
Aetna	$6 - $295	70%
Blue Shield Epn - All Other Plans	$6 - $303	70%
Blue Shield Non-Epn	$6 - $303	70%
First Health- All Plans	$6 - $316	70%
Foundation- All Plans	$6 - $336	70%
Health Mgmt Network- All Plans	$6 - $336	70%
Healthnet- All Plans	$6 - $324	70%
Humana	$6 - $336	70%
Phcs- All Plans	$6 - $336	70%
UnitedHealthcare	$6 - $329	70%
Western Growers- All Plans	$6 - $296	70%
Cigna	$7 - $356	81%
Interplan- All Plans	$7 - $356	81%
Kaiser- All Other Plans	$7 - $356	81%
Three Rivers Provider Network- All Plans	$7 - $356	81%
Bc Managed Mcal	$8 - $10	93%
Medi-Cal	$8 - $10	93%
Partnership Mcal - All Plans	$8 - $10	93%

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 $86.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 87070.

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 87070.
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.