CMS Price Transparency Data

X-ray, lower back

Facility: Adventist Health Clearlake

Billing Code: 72110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72110
Insurance Median: $1,148
Cash Discount Price: $525
vs. Medicare Baseline: 10.75x Medicare

The contracted insurance negotiated median rate for a X-ray, lower back at Adventist Health Clearlake is $1,148. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $525. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 10.75x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$525

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,148

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $525 (492%)

Insurance Median: $1,148 (1075%)

Cash: $525 (492% of Medicare)

Ins. Median: $1,148 (1075% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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 1075% of the Medicare baseline (a markup of 975%). 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	$63	59%
Medi-Cal	$63	59%
Blue Cross Blue Shield	$230 - $337	215%
Blue Shield Mcr Adv	$289 - $324	271%
Kaiser Mcr Adv	$289 - $324	271%
Tricare	$289 - $324	271%
UnitedHealthcare	$318 - $1,286	298%
Blue Shield Epn - All Other Plans	$338	316%
Blue Shield Non-Epn	$354	331%
Ah Employee Health Plan - All Plans	$578 - $648	541%
Aetna	$1,029 - $1,152	963%
Western Growers- All Plans	$1,033 - $1,156	967%
First Health- All Plans	$1,102 - $1,234	1032%
Healthnet- All Plans	$1,129 - $1,264	1057%
Foundation- All Plans	$1,170 - $1,311	1095%
Health Mgmt Network- All Plans	$1,170 - $1,311	1095%
Humana	$1,170 - $1,311	1095%
Phcs- All Plans	$1,170 - $1,311	1095%
Cigna	$1,239 - $1,388	1160%
Interplan- All Plans	$1,239 - $1,388	1160%
Kaiser- All Other Plans	$1,239 - $1,388	1160%
Three Rivers Provider Network- All Plans	$1,239 - $1,388	1160%
Partnership Mcal - All Plans	$2,272 - $2,544	2127%

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 $525.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72110.

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 72110.
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.