ADVENTIST HEALTH CLEARLAKE HOSPITAL
15630 18th Ave, Clearlake, CA · Adventisthealth · · NPI 1124018031
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Interrog dev eval scrms ip CPT 93291 | $20.88 | $58.00 | $52.11 – $160.31 | 6 |
| Interrog device eval heart CPT 93289 | $47.52 | $132.00 | $83.48 – $217.80 | 6 |
| Interrog evl pm/ldls pm ip CPT 93288 | $35.28 | $98.00 | $54.54 – $179.04 | 6 |
| Intraoral periapical first HCPCS D0220 | $20.88 | $58.00 | $10.52 – $107.30 | 10 |
| Intrinsic factor antibody CPT 86340 | $4.82 | $13.40 | $2.02 – $176.21 | 7 |
| Intro long gi tube w/mult fluo CPT 74340 | $434.16 | $1,206.00 | $657.31 – $1,989.90 | 8 |
| Intubation endotracheal emergency procedure CPT 31500 | $318.96 | $886.00 | $59.20 – $1,461.90 | 3 |
| Iopamidol 250 mg iodine/ml (51 %) intravenous solution HCPCS Q9966 | $2.29 | $6.36 | $0.83 – $6.36 | 8 |
| Iopamidol 300 mg iodine/ml (61 %) intravenous solution HCPCS Q9967 | $2.67 | $7.42 | $0.41 – $6.36 | 8 |
| Ipratropium bromide non-comp HCPCS J7644 | $1.57 | $4.37 | $1.09 – $9.39 | 8 |
| Iron CPT 83540 | $61.20 | $170.00 | $0.37 – $75.71 | 7 |
| Iron binding capacity CPT 83550 | $56.52 | $157.00 | $0.60 – $79.96 | 7 |
| Iron sucrose 20 mg iron/ml intravenous solution (wrapper) HCPCS J1756 | $110.40 | $306.68 | $0.66 – $306.68 | 8 |
| Irrigation implantable venous access device for drug delivery systems CPT 96523 | $479.16 | $1,331.00 | $2,196.15 – $2,196.15 | 1 |
| IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour CPT 96367 | $291.96 | $811.00 | $44.54 – $1,338.15 | 3 |
| IV infusion therapy/prophylaxis/diagnosis concurrent infusion CPT 96368 | $306.00 | $850.00 | $25.76 – $1,402.50 | 3 |
| IV infusion therapy/prophylaxis/diagnosis each additional 1 hour CPT 96366 | $306.00 | $850.00 | $27.64 – $1,402.50 | 3 |
| IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour CPT 96365 | $548.28 | $1,523.00 | $89.79 – $2,512.95 | 3 |
| Ivp w/nephrotomography CPT 74415 | $1,345.68 | $3,738.00 | $142.46 – $6,167.70 | 8 |
| Ivp w/wo kub w/wo tomography CPT 74400 | $769.68 | $2,138.00 | $94.30 – $3,527.70 | 8 |
| Jak2 targeted sequence analysis CPT 81279 | $61.20 | $170.00 | $65.08 – $1,224.34 | 7 |
| John cunningham antibody CPT 86711 | $10.80 | $30.00 | $3.38 – $212.65 | 7 |
| Ketamine and metabolite screen - quest CPT 80357 | $38.16 | $106.00 | $8.00 – $249.09 | 7 |
| Ketone body(s) beta-hydroxybutyrate quantitative CPT 82010 | $113.76 | $316.00 | $0.58 – $94.99 | 7 |
| Ketorolac 15 mg/ml injection (wrapper) HCPCS J1885 | $24.21 | $67.26 | $0.89 – $23.94 | 8 |
| Kidney img w/bldflw sgl without rx CPT 78707 | $1,521.72 | $4,227.00 | $276.77 – $6,974.55 | 6 |
| Kidney (Retroperitoneal) Ultrasound (complete) CPT 76770 | $445.32 | $1,237.00 | $115.78 – $947.10 | 6 |
| Kit gene analys d816 variant CPT 81273 | $100.80 | $280.00 | $143.28 – $1,816.47 | 7 |
| Kit hfx iq ipg bundle HCPCS C1822 | $47,700.00 | $132,500.00 | $45,540.00 – $45,540.00 | 2 |
| Kit lead specify 5-6-5 HCPCS C1778 | $1,350.00 | $3,750.00 | $3,750.00 – $6,187.50 | 3 |
| Kit montgmry thyrplasty impl f 5 implants 1meas dev inst set HCPCS C1878 | $1,677.60 | $4,660.00 | $4,660.00 – $7,689.00 | 3 |
| Knee MRI (with and without contrast) CPT 73723 | $3,993.48 | $11,093.00 | $822.18 – $12,201.75 | 8 |
| Knee MRI (with contrast) CPT 73722 | $2,700.00 | $7,500.00 | $654.95 – $8,250.00 | 8 |
| Knee MRI (without contrast) CPT 73721 | $2,383.56 | $6,621.00 | $560.10 – $7,095.00 | 8 |
| Knee X-ray CPT 73564 | $455.40 | $1,265.00 | $39.73 – $1,390.95 | 8 |
| Kyleena, 19.5 mg HCPCS J7296 | $885.60 | $2,460.00 | $1,832.24 – $4,157.06 | 8 |
| Labetalol 5 mg/ml IV (wrapper) HCPCS J1920 | $15.01 | $41.71 | $0.55 – $41.71 | 6 |
| Lactate dehydrogenase (ldh) CPT 83615 | $56.16 | $156.00 | $0.32 – $70.36 | 7 |
| Lactated ringers intravenous solution HCPCS J7120 | $35.57 | $98.80 | $6.48 – $43.45 | 8 |
| Lactation class HCPCS S9443 | $41.76 | $116.00 | $116.00 – $191.40 | 3 |
| Lactic acid CPT 83605 | $103.68 | $288.00 | $1.09 – $124.82 | 7 |
| Lactoferrin fecal qualitative CPT 83630 | $6.28 | $17.45 | $3.44 – $106.40 | 7 |
| Lanreotide 120 mg/0.5 ml subcutaneous syringe HCPCS J1930 | $9,900.00 | $27,500.00 | $55.90 – $104.60 | 8 |
| Laryngoscopic sensory vid CPT 92614 | $177.48 | $493.00 | $122.93 – $813.45 | 8 |
| Lead capillary CPT 83655 | $31.68 | $88.00 | $1.29 – $141.50 | 7 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $904.32 | $2,512.00 | $241.32 – $1,489.08 | 6 |
| Leishmania antibody CPT 86717 | $3.92 | $10.89 | $1.33 – $143.39 | 7 |
| Lens, intraocular (new tech) HCPCS C1780 | $365.04 | $1,014.00 | $667.00 – $1,100.55 | 3 |
| Lens iol 23.0 d 1.5 cyl eyhance toric HCPCS V2787 | $1,012.32 | $2,812.00 | $7.15 – $325.62 | 8 |
| Lens iol ant bicnvx 24.0 multi HCPCS V2632 | $1,608.84 | $4,469.00 | $686.40 – $686.40 | 1 |
| Lens iol ant chamb 10.5 HCPCS V2630 | $362.52 | $1,007.00 | $1,661.55 – $1,661.55 | 1 |
| Leuprolide 30 mg (4 month) intramuscular syringe kit HCPCS J9217 | $11,404.54 | $31,679.29 | $334.77 – $1,524.20 | 8 |
| Leuprolide 3.75 mg intramuscular syringe kit HCPCS J1950 | $9,570.45 | $26,584.58 | $958.94 – $4,802.14 | 8 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $11.51 | $31.96 | $0.12 – $31.96 | 8 |
| Levetiracetam therapeutic drug level CPT 80177 | $55.08 | $153.00 | $1.56 – $148.74 | 7 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $21.81 | $60.58 | $5.87 – $52.11 | 8 |
| Levothyroxine 100 mcg intravenous powder for solution HCPCS J0650 | $191.47 | $531.87 | $16.29 – $531.87 | 6 |
| Liberta rc ipg HCPCS C1820 | $29,340.00 | $81,500.00 | $6,000.00 – $6,000.00 | 2 |
| Lidocaine (pf) 10 mg/ml (1 %) injection solution HCPCS J2003 | $28.05 | $77.92 | $0.13 – $2.71 | 6 |
| Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution HCPCS J2002 | $1.57 | $4.37 | $0.03 – $4.37 | 6 |
| Lidocaine therapeutic drug level CPT 80176 | $35.64 | $99.00 | $14.54 – $171.64 | 7 |
| Liletta, 52 mg HCPCS J7297 | $522.00 | $1,450.00 | $1,334.16 – $3,196.17 | 8 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $61.36 | $170.44 | $7.46 – $170.44 | 8 |
| Lipase CPT 83690 | $86.76 | $241.00 | $0.42 – $80.43 | 7 |
| Lipoprotein blood high res frac & quant CPT 83701 | $8.91 | $24.75 | $8.38 – $283.87 | 7 |
| Lipoprotein blood quant CPT 83704 | $10.10 | $28.05 | $9.59 – $360.76 | 7 |
| Lipoprotein direct measurement hdl CPT 83718 | $60.12 | $167.00 | $0.55 – $95.62 | 7 |
| Lipoprotein direct measurement ldl CPT 83721 | $43.56 | $121.00 | $0.86 – $110.26 | 7 |
| Lithium therapeutic drug level CPT 80178 | $56.16 | $156.00 | $0.39 – $77.20 | 7 |
| Liver Function Test CPT 80076 | $84.24 | $234.00 | $1.04 – $95.54 | 7 |
| Liver/spleen imag static only CPT 78215 | $934.20 | $2,595.00 | $124.10 – $4,281.75 | 6 |
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | $1.53 | $4.24 | $0.69 – $2.84 | 8 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $17.77 | $49.37 | $3.84 – $49.37 | 8 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $1,831.68 | $5,088.00 | $352.37 – $8,395.20 | 8 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $1,859.40 | $5,165.00 | $296.65 – $7,928.25 | 8 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $1,796.04 | $4,989.00 | $232.06 – $7,613.10 | 8 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $2,233.08 | $6,203.00 | $583.81 – $9,641.34 | 8 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $2,160.00 | $6,000.00 | $485.48 – $8,929.80 | 8 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $1,784.52 | $4,957.00 | $390.06 – $7,083.45 | 8 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $355.32 | $987.00 | $43.45 – $1,427.25 | 8 |
| Lung function test (mbc/mvv) CPT 94200 | $321.84 | $894.00 | $2.61 – $78.09 | 22 |
| Lung Function Test (Spirometry) CPT 94010 | $305.64 | $849.00 | $8.52 – $128.91 | 22 |
| Lung perfusion imaging CPT 78580 | $1,243.80 | $3,455.00 | $161.37 – $5,700.75 | 6 |
| Lymphatics/lymph node imaging CPT 78195 | $1,820.52 | $5,057.00 | $271.89 – $8,344.05 | 6 |
| Lymphocyte transformation mitogen CPT 86353 | $56.52 | $157.00 | $21.37 – $573.01 | 7 |
| Macroscopic exam arthropod CPT 87168 | $49.36 | $137.10 | $0.47 – $49.90 | 7 |
| Macroscopic exam parasite CPT 87169 | $7.92 | $22.00 | $0.16 – $49.90 | 7 |
| Magnesium CPT 83735 | $53.64 | $149.00 | $0.40 – $77.83 | 7 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $32.80 | $91.11 | $0.83 – $27.92 | 8 |
| Makena, 10 mg HCPCS J1726 | $99.36 | $276.00 | $65.30 – $276.00 | 6 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $177.48 | $493.00 | $16.78 – $813.45 | 8 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $166.68 | $463.00 | $28.54 – $763.95 | 8 |
| Marker biop eviva buckle ss HCPCS A4648 | $352.08 | $978.00 | $541.00 – $892.65 | 3 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $4.63 | $12.86 | $1.86 – $168.97 | 7 |
| Mayo aathr protein s free CPT 85306 | $4.90 | $13.62 | $2.09 – $179.20 | 7 |
| Mayo activated protein c resistance assay CPT 85307 | $4.90 | $13.62 | $2.09 – $179.04 | 7 |
| Mayo adalimumab (humira) therapeutic drug level CPT 80145 | $504.00 | $1,400.00 | $44.25 – $254.99 | 7 |
| Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation CPT 80321 | $34.77 | $96.59 | $11.94 – $193.37 | 7 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $72.36 | $201.00 | $11.94 – $193.37 | 7 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $6.41 | $17.80 | $1.94 – $172.90 | 7 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.