CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: Adventist Health Clearlake

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72148
Insurance Median: $3,649
Cash Discount Price: $1,665
vs. Medicare Baseline: 14.97x Medicare

The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at Adventist Health Clearlake is $3,649. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,665. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 14.97x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$1,665

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,649

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: $1,665 (683%)

Insurance Median: $3,649 (1497%)

Cash: $1,665 (683% of Medicare)

Ins. Median: $3,649 (1497% 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 1497% of the Medicare baseline (a markup of 1397%). 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	$390	160%
Medi-Cal	$390	160%
Blue Shield Mcr Adv	$902 - $1,041	370%
Kaiser Mcr Adv	$902 - $1,041	370%
Tricare	$902 - $1,041	370%
Blue Cross Blue Shield	$938 - $2,250	385%
UnitedHealthcare	$992 - $4,134	407%
Ah Employee Health Plan - All Plans	$1,803 - $2,082	740%
Aetna	$3,208 - $3,704	1316%
Western Growers- All Plans	$3,220 - $3,718	1321%
First Health- All Plans	$3,434 - $3,966	1409%
Healthnet- All Plans	$3,520 - $4,065	1444%
Foundation- All Plans	$3,649 - $4,213	1497%
Health Mgmt Network- All Plans	$3,649 - $4,213	1497%
Humana	$3,649 - $4,213	1497%
Phcs- All Plans	$3,649 - $4,213	1497%
Cigna	$3,864 - $4,461	1585%
Interplan- All Plans	$3,864 - $4,461	1585%
Kaiser- All Other Plans	$3,864 - $4,461	1585%
Three Rivers Provider Network- All Plans	$3,864 - $4,461	1585%
Blue Shield Epn - All Other Plans	$4,595	1885%
Blue Shield Non-Epn	$4,813	1974%
Partnership Mcal - All Plans	$7,083 - $8,179	2906%

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 $1,665.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72148.

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 72148.
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.