CMS Price Transparency Data

Culture, blood

Facility: Adventist Health Clearlake

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $110
Cash Discount Price: $139
vs. Medicare Baseline: 10.66x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Adventist Health Clearlake is $110. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $139. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 10.66x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$139

Average discount available for prompt cash payment at this facility.

Insurance Median

$110

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$10.32

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $10.32 (100%)

Cash / Self-Pay: $139 (1347%)

Insurance Median: $110 (1066%)

Cash: $139 (1347% of Medicare)

Ins. Median: $110 (1066% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $10.32 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 1066% of the Medicare baseline (a markup of 966%). 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 - $121	19%
Blue Shield Mcr Adv	$2 - $110	19%
Kaiser Mcr Adv	$2 - $110	19%
Tricare	$2 - $110	19%
Ah Employee Health Plan - All Plans	$4 - $220	39%
Aetna	$7 - $392	68%
Blue Shield Epn - All Other Plans	$7 - $403	68%
Blue Shield Non-Epn	$7 - $403	68%
First Health- All Plans	$7 - $420	68%
Healthnet- All Plans	$7 - $430	68%
UnitedHealthcare	$7 - $438	68%
Western Growers- All Plans	$7 - $394	68%
Cigna	$8 - $472	78%
Foundation- All Plans	$8 - $446	78%
Health Mgmt Network- All Plans	$8 - $446	78%
Humana	$8 - $446	78%
Interplan- All Plans	$8 - $472	78%
Kaiser- All Other Plans	$8 - $472	78%
Phcs- All Plans	$8 - $446	78%
Three Rivers Provider Network- All Plans	$8 - $472	78%
Bc Managed Mcal	$9 - $12	87%
Medi-Cal	$9 - $12	87%
Partnership Mcal - All Plans	$9 - $12	87%

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 $139.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 87040.

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 87040.
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.