CMS Price Transparency Data

Ultrasound, pelvis

Facility: Adventist Health and Rideout

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $1,381
Cash Discount Price: $430
vs. Medicare Baseline: 12.93x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Adventist Health and Rideout is $1,381. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $430. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 12.93x the Medicare baseline. Located in 726 4Th St, Marysville, CA.

Cash / Self-Pay

$430

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,381

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: $430 (403%)

Insurance Median: $1,381 (1293%)

Cash: $430 (403% of Medicare)

Ins. Median: $1,381 (1293% 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 1293% of the Medicare baseline (a markup of 1193%). 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 Mcal	$42	39%
Kaiser Mcal	$97	91%
Medi-Cal	$97	91%
Ca Health And Wellness- All Plans	$120	112%
Celtic Mcaid-All Plans	$120	112%
Kaiser Mcr Adv	$135	126%
Tricare	$135	126%
UnitedHealthcare	$135 - $1,697	126%
Blue Cross Blue Shield	$136 - $1,505	127%
Ah Employee Health Plan - All Plans	$243	228%
Healthnet Mcal	$391	366%
Healthnet Comm-All Other Plans	$1,256	1176%
Aetna	$1,381	1293%
Kaiser-All Other Plans	$1,485	1390%
Blue Shield Uc Care Members	$1,563	1463%
Cigna	$1,665	1559%
First Health-All Plans	$1,710	1601%
Phcs-All Plans	$1,720	1610%
Interplan-All Plans	$1,759	1647%
Blue Shield-All Other Plans	$1,856	1738%
Multiplan-All Plans	$1,856	1738%
Partnership Hp Mcal -All Plans	$3,224	3018%

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 $430.
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 and Rideout 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.