CMS Price Transparency Data

Ultrasound, pelvis

Facility: Adventist Health Clearlake

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $536
Cash Discount Price: $479
vs. Medicare Baseline: 5.02x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Adventist Health Clearlake is $536. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $479. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.02x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$479

Average discount available for prompt cash payment at this facility.

Insurance Median

$536

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: $479 (448%)

Insurance Median: $536 (502%)

Cash: $479 (448% of Medicare)

Ins. Median: $536 (502% 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 502% of the Medicare baseline (a markup of 402%). 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	$97	91%
Medi-Cal	$97	91%
Blue Shield Mcr Adv	$115 - $301	108%
Kaiser Mcr Adv	$115 - $301	108%
Tricare	$115 - $301	108%
Blue Cross Blue Shield	$120 - $513	112%
UnitedHealthcare	$127 - $1,195	119%
Ah Employee Health Plan - All Plans	$230 - $602	215%
Aetna	$409 - $1,071	383%
Western Growers- All Plans	$411 - $1,075	385%
Blue Shield Epn - All Other Plans	$421 - $1,101	394%
Blue Shield Non-Epn	$421 - $1,101	394%
First Health- All Plans	$438 - $1,146	410%
Healthnet- All Plans	$449 - $1,175	420%
Foundation- All Plans	$466 - $1,218	436%
Health Mgmt Network- All Plans	$466 - $1,218	436%
Humana	$466 - $1,218	436%
Phcs- All Plans	$466 - $1,218	436%
Cigna	$493 - $1,290	462%
Interplan- All Plans	$493 - $1,290	462%
Kaiser- All Other Plans	$493 - $1,290	462%
Three Rivers Provider Network- All Plans	$493 - $1,290	462%
Partnership Mcal - All Plans	$904 - $2,364	846%

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 $479.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 76856.

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 76856.
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.