CMS Price Transparency Data

X-ray, pelvis

Facility: Adventist Health Clearlake

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $679
Cash Discount Price: $314
vs. Medicare Baseline: 6.36x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Adventist Health Clearlake is $679. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $314. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 6.36x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$314

Average discount available for prompt cash payment at this facility.

Insurance Median

$679

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: $314 (294%)

Insurance Median: $679 (636%)

Cash: $314 (294% of Medicare)

Ins. Median: $679 (636% 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 636% of the Medicare baseline (a markup of 536%). 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	$31	29%
Medi-Cal	$31	29%
Blue Cross Blue Shield	$131 - $204	123%
Blue Shield Mcr Adv	$171 - $196	160%
Kaiser Mcr Adv	$171 - $196	160%
Tricare	$171 - $196	160%
UnitedHealthcare	$188 - $777	176%
Blue Shield Epn - All Other Plans	$190	178%
Blue Shield Non-Epn	$199	186%
Ah Employee Health Plan - All Plans	$342 - $391	320%
Aetna	$608 - $696	569%
Western Growers- All Plans	$610 - $699	571%
First Health- All Plans	$651 - $746	609%
Healthnet- All Plans	$667 - $764	624%
Foundation- All Plans	$692 - $792	648%
Health Mgmt Network- All Plans	$692 - $792	648%
Humana	$692 - $792	648%
Phcs- All Plans	$692 - $792	648%
Cigna	$733 - $839	686%
Interplan- All Plans	$733 - $839	686%
Kaiser- All Other Plans	$733 - $839	686%
Three Rivers Provider Network- All Plans	$733 - $839	686%
Partnership Mcal - All Plans	$1,343 - $1,538	1257%

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 $314.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72170.

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 72170.
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.