CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Adventist Health Clearlake

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $3,752
Cash Discount Price: $1,956
vs. Medicare Baseline: 15.39x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Adventist Health Clearlake is $3,752. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,956. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 15.39x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$1,956

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,752

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: $1,956 (802%)

Insurance Median: $3,752 (1539%)

Cash: $1,956 (802% of Medicare)

Ins. Median: $3,752 (1539% 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 1539% of the Medicare baseline (a markup of 1439%). 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	$560	230%
Medi-Cal	$560	230%
Blue Shield Mcr Adv	$903 - $1,390	370%
Kaiser Mcr Adv	$903 - $1,390	370%
Tricare	$903 - $1,390	370%
Blue Cross Blue Shield	$939 - $2,022	385%
UnitedHealthcare	$993 - $5,522	407%
Ah Employee Health Plan - All Plans	$1,806 - $2,781	741%
Aetna	$3,213 - $4,947	1318%
Western Growers- All Plans	$3,225 - $4,966	1323%
First Health- All Plans	$3,440 - $5,297	1411%
Healthnet- All Plans	$3,526 - $5,429	1446%
Foundation- All Plans	$3,655 - $5,628	1499%
Health Mgmt Network- All Plans	$3,655 - $5,628	1499%
Humana	$3,655 - $5,628	1499%
Phcs- All Plans	$3,655 - $5,628	1499%
Cigna	$3,870 - $5,959	1588%
Interplan- All Plans	$3,870 - $5,959	1588%
Kaiser- All Other Plans	$3,870 - $5,959	1588%
Three Rivers Provider Network- All Plans	$3,870 - $5,959	1588%
Blue Shield Epn - All Other Plans	$4,091	1678%
Blue Shield Non-Epn	$4,285	1758%
Partnership Mcal - All Plans	$7,095 - $10,925	2911%

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 $1,956.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 73721.

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 73721.
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.