CMS Price Transparency Data

X-ray, neck (cervical spine)

Facility: Adventist Health Clearlake

Billing Code: 72040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72040
Insurance Median: $694
Cash Discount Price: $321
vs. Medicare Baseline: 7.81x Medicare

The contracted insurance negotiated median rate for a X-ray, neck (cervical spine) at Adventist Health Clearlake is $694. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $321. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 7.81x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$321

Average discount available for prompt cash payment at this facility.

Insurance Median

$694

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$88.91

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $88.91 (100%)

Cash / Self-Pay: $321 (361%)

Insurance Median: $694 (781%)

Cash: $321 (361% of Medicare)

Ins. Median: $694 (781% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $88.91 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 781% of the Medicare baseline (a markup of 681%). 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	$37	42%
Medi-Cal	$37	42%
Blue Cross Blue Shield	$151 - $202	170%
Blue Shield Mcr Adv	$181 - $194	204%
Kaiser Mcr Adv	$181 - $194	204%
Tricare	$181 - $194	204%
UnitedHealthcare	$199 - $771	224%
Blue Shield Epn - All Other Plans	$223	251%
Blue Shield Non-Epn	$234	263%
Ah Employee Health Plan - All Plans	$361 - $388	406%
Aetna	$643 - $691	723%
Western Growers- All Plans	$645 - $694	725%
First Health- All Plans	$688 - $740	774%
Healthnet- All Plans	$705 - $758	793%
Foundation- All Plans	$731 - $786	822%
Health Mgmt Network- All Plans	$731 - $786	822%
Humana	$731 - $786	822%
Phcs- All Plans	$731 - $786	822%
Cigna	$774 - $832	871%
Interplan- All Plans	$774 - $832	871%
Kaiser- All Other Plans	$774 - $832	871%
Three Rivers Provider Network- All Plans	$774 - $832	871%
Partnership Mcal - All Plans	$1,419 - $1,526	1596%

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 $321.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72040.

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 72040.
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.