CMS Price Transparency Data

Ultrasound, pelvis

Facility: Adventist Health Reedley

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $131
Cash Discount Price: $82
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Adventist Health Reedley is $131. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $82. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.23x the Medicare baseline. Located in 372 W Cypress Ave, Reedley, CA.

Cash / Self-Pay

$82

Average discount available for prompt cash payment at this facility.

Insurance Median

$131

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: $82 (77%)

Insurance Median: $131 (123%)

Cash: $82 (77% of Medicare)

Ins. Median: $131 (123% 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
Healthnet Medi-Cal	$19 - $220	18%
Blue Shield Mcare	$33 - $134	31%
Fhcn Pace Mcr Adv-All Plans	$33 - $134	31%
Lasalle Med Assoc Profee Only - All Plans	$33	31%
Tricare	$33 - $134	31%
UnitedHealthcare	$33 - $617	31%
Upn Mcr Adv Profee Only	$33	31%
Ah Employee Health Plan - All Plans	$36 - $242	34%
Blue Shield Epn - All Other Plans	$40 - $648	37%
Cigna	$40 - $954	37%
Community Care Ipa Mcal-All Plans	$40 - $126	37%
Blue Shield Non Epn	$43 - $751	40%
Kaiser - All Other Plans	$45 - $734	42%
Kaiser Mcr Adv	$45 - $134	42%
Healthnet- All Other Plans	$48 - $638	45%
Western Growers/Pinnacle- All Plans	$49 - $675	46%
Bc Mcal	$52 - $68	49%
Blue Cross Blue Shield	$61 - $562	57%
Cal Viva Hlth Mcal - All Plans	$68 - $97	64%
Central Ca Alliance Mcal Profee Only	$68	64%
Dignity Mcal Op/Profee Only-All Other Plans	$68 - $107	64%
Medi-Cal	$68 - $97	64%
Upn Mcal Profee Only-All Other Plans	$68	64%
Aetna	$83 - $414	78%
Kern Health Systems Mcal-All Plans	$85 - $97	80%
Central Ca Alliance Ccs Profee Only	$101	95%
Central Ca Alliance Comm Profee Only - All Other P	$101	95%
Physicians Med Group Op/Profee Only- All Plans	$102 - $1,174	95%
Central Ca Alliance Chdp Profee Only	$128 - $135	120%
Dignity Mcr Adv Op/Profee Only	$134	125%
Healthnet- Mcr Adv	$134	125%
Phs Prime Health Srvcs	$134	125%
Bright Health Mcr Adv - All Plans	$211	198%

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 $82.
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 Reedley 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.