CMS Price Transparency Data

Ultrasound, pelvis

Facility: St Marys Good Samaritan Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 76856
  • Insurance Median: $207
  • Cash Discount Price: $498
  • vs. Medicare Baseline: 1.94x Medicare
The contracted insurance negotiated median rate for a Ultrasound, pelvis at St Marys Good Samaritan Hospital is $207. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $498. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.94x the Medicare baseline. Located in 5401 Lake Oconee Parkway, Greensboro, GA.
Cash / Self-Pay
$498

Average discount available for prompt cash payment at this facility.

Insurance Median
$207

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: $498 (466%)
Insurance Median: $207 (194%)
Cash: $498 (466% of Medicare)
Ins. Median: $207 (194% 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.

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
Peach State $86 81%
Wellcare $86 - $207 81%
Blue Cross Blue Shield $148 - $553 139%
Aetna $207 - $613 194%
Ambetter / Centene $207 194%
Care Improvement Plus $207 194%
Caresource $207 194%
Cigna $207 - $628 194%
Coventry $207 - $574 194%
Eon Health Plan $207 194%
Humana $207 - $574 194%
Kaiser Permanente $207 194%
Molina $207 194%
Pruitthealth Premier $207 194%
Todays Options Pffs $207 194%
Todays Options Ppo $207 194%
UnitedHealthcare $207 - $2,632 194%
Vaccn United $207 194%
First Health $574 537%
Phcs $574 537%
Meritain $613 574%
Multiplan $651 - $666 609%
Nova $651 - $689 609%
Three Rivers Provider Network $689 645%
Amerigroup $766 717%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 5401 Lake Oconee Parkway, Greensboro, GA 30642
  • CMS Rating: ★★★★☆
  • Ownership Type: Proprietary
  • Hospital Type: Critical Access Hospitals