CMS Price Transparency Data

Ultrasound, pelvis

Facility: Clarion Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $137
Cash Discount Price: $225
vs. Medicare Baseline: 1.28x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Clarion Hospital is $137. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $225. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.28x the Medicare baseline. Located in One Hospital Drive, Clarion, PA.

Cash / Self-Pay

$225

Average discount available for prompt cash payment at this facility.

Insurance Median

$137

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: $225 (211%)

Insurance Median: $137 (128%)

Cash: $225 (211% of Medicare)

Ins. Median: $137 (128% 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.

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
Upmc	$58 - $263	54%
Medicaid / KanCare	$76	71%
Amerihealth	$84 - $102	79%
Jefferson Health Plan	$84	79%
Geisinger	$92 - $107	86%
Highmark	$101 - $170	95%
Cigna	$102 - $201	95%
Highmark Community Blue	$102	95%
Martin'S Point - Usfhp	$102 - $141	95%
Medicare (plans)	$102	95%
Tricare	$102	95%
UnitedHealthcare	$102	95%
Aetna	$105 - $358	98%
Devoted Health Plan	$108 - $161	101%
The Health Plan	$108 - $240	101%
Gateway	$109 - $149	102%
Pa Health & Wellness	$109	102%
American Health Plan	$113	106%
Highmark - Ind.& Managed Care	$137 - $230	128%
Workers Comp	$231	216%
Peak Health	$240 - $281	225%
Devon	$302	283%

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 $225.
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 Clarion Hospital 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.