CMS Price Transparency Data

MRI, brain (no contrast)

Facility: Adventist Health Clearlake

Billing Code: 70551 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70551
Insurance Median: $3,503
Cash Discount Price: $1,584
vs. Medicare Baseline: 14.37x Medicare

The contracted insurance negotiated median rate for a MRI, brain (no contrast) at Adventist Health Clearlake is $3,503. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,584. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 14.37x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$1,584

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,503

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)

Cash / Self-Pay: $1,584 (650%)

Insurance Median: $3,503 (1437%)

Cash: $1,584 (650% of Medicare)

Ins. Median: $3,503 (1437% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 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 1437% of the Medicare baseline (a markup of 1337%). 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	$439	180%
Medi-Cal	$439	180%
Blue Shield Mcr Adv	$924	379%
Kaiser Mcr Adv	$924	379%
Tricare	$924	379%
Blue Cross Blue Shield	$961 - $2,029	394%
UnitedHealthcare	$1,016 - $3,670	417%
Ah Employee Health Plan - All Plans	$1,848	758%
Aetna	$3,288	1349%
Western Growers- All Plans	$3,300	1354%
First Health- All Plans	$3,520	1444%
Healthnet- All Plans	$3,608	1480%
Foundation- All Plans	$3,740	1534%
Health Mgmt Network- All Plans	$3,740	1534%
Humana	$3,740	1534%
Phcs- All Plans	$3,740	1534%
Cigna	$3,960	1624%
Interplan- All Plans	$3,960	1624%
Kaiser- All Other Plans	$3,960	1624%
Three Rivers Provider Network- All Plans	$3,960	1624%
Blue Shield Epn - All Other Plans	$4,142	1699%
Blue Shield Non-Epn	$4,338	1780%
Partnership Mcal - All Plans	$7,260	2978%

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 $1,584.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70551.

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 70551.
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.