CMS Price Transparency Data

Ultrasound, pelvis

Facility: Clearwater Valley Hospital & Clinics

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $326
Cash Discount Price: $290
vs. Medicare Baseline: 3.05x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Clearwater Valley Hospital & Clinics is $326. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $290. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.05x the Medicare baseline. Located in 301 Cedar Street, Orofino, ID.

Cash / Self-Pay

$290

Average discount available for prompt cash payment at this facility.

Insurance Median

$326

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: $290 (272%)

Insurance Median: $326 (305%)

Cash: $290 (272% of Medicare)

Ins. Median: $326 (305% 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 305% of the Medicare baseline (a markup of 205%). 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
Humana	$31 - $661	29%
Nimiipuu Mcr Adv-All Plans	$31 - $371	29%
Regence Blue Shield Mcr	$31 - $368	29%
Veterans Amin-All Plans	$31 - $368	29%
Pacific Source - All Plans	$32 - $368	30%
Blue Cross Blue Shield	$36 - $497	34%
Aetna	$50 - $633	47%
UnitedHealthcare	$57	53%
Cigna	$65 - $613	61%
Idaho Phys Network-All Plans	$86 - $647	81%
Multiplan / Phcs-All Plans	$87 - $661	81%
Geha-All Plans	$88 - $667	82%
First Choice-All Plans	$89 - $667	83%
Corizon Correctnal Med-All Plans	$105 - $497	98%
Regence Blue Shield-All Other Plans	$681	638%

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 $290.
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 Clearwater Valley Hospital & Clinics 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.