CMS Price Transparency Data

Ultrasound, pelvis

Facility: Doctors Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $473
Cash Discount Price: $2,509
vs. Medicare Baseline: 4.43x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Doctors Hospital is $473. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,509. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.43x the Medicare baseline. Located in 3651 Wheeler Road, Augusta, GA.

Cash / Self-Pay

$2,509

Average discount available for prompt cash payment at this facility.

Insurance Median

$473

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: $2,509 (2349%)

Insurance Median: $473 (443%)

Cash: $2,509 (2349% of Medicare)

Ins. Median: $473 (443% 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 443% of the Medicare baseline (a markup of 343%). 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
Blue Cross Blue Shield	$47 - $210	44%
Blue Choice	$99	93%
Health One Alliance	$118 - $1,162	110%
Ambetter / Centene	$142	133%
Aetna	$172 - $1,393	161%
United	$245 - $1,137	229%
Prime Health	$267	250%
Rockport United Network	$273	256%
Identity Mco	$279	261%
Amerigroup	$354 - $359	331%
Absolute Total Care	$448 - $455	419%
Nhc Advantage	$473 - $480	443%
Pruitt Health	$473 - $480	443%
Peach State	$498 - $505	466%
Wellcare	$498 - $505	466%
Centurion	$690 - $699	646%
Americas 1St Choice	$698 - $707	653%
Medcost	$1,248 - $1,614	1168%
Multiplan	$1,495 - $2,274	1400%
Performax	$1,694 - $1,718	1586%
First Health	$1,869 - $1,895	1750%
Employer'S Health Network	$1,993 - $2,021	1866%
Novanet	$2,242 - $2,274	2099%

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 $2,509.
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 Doctors 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.