Ultrasound, pelvis
Facility: Golden Valley Memorial Hospital
Billing Code: 76856 (CPT)
- CPT Billing Code: 76856
- Insurance Median: $107
- Cash Discount Price: $653
- vs. Medicare Baseline: 1.00x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Home State Health | $98 | 92% |
| UnitedHealthcare | $98 - $182 | 92% |
| Aetna | $107 | 100% |
| Humana | $107 | 100% |
| Ambetter / Centene | $128 | 120% |
Consumer Guidance & Cost Commentary
This Ultrasound, pelvis procedure at Golden Valley Memorial Hospital in Clinton, Missouri, is priced significantly lower than the facility's gross charge of $1,088. The cash median rate of $653 represents a substantial discount off the list price, and for patients with high-deductible plans, paying this cash rate may be more cost-effective than using insurance if the negotiated rates exceed the cash price. While the facility's negotiated rate is $107, commercial payers such as UnitedHealthcare and Ambetter / Centene have agreed rates ranging from $98 to $182 depending on the specific plan, which are generally higher than the cash option.
When compared to federal benchmarks, the facility's pricing structure is transparent against the Medicare amount of $106.81, with the cash rate remaining well below the gross charge. Although the data does not include specific state or county average figures for this procedure, the facility's ownership by the Government - Hospital District or Authority often influences its pricing strategy to remain competitive within the community. Patients are encouraged to verify their specific plan details before scheduling, as some in-network members may face higher costs than the cash-pay alternative. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by bypassing administrative fees and providing immediate liquidity incentives.