CMS Price Transparency Data

Ultrasound, pelvis

Facility: Atrium Health Navicent Rehabilitation Hopsital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $108
Cash Discount Price: $316
vs. Medicare Baseline: 1.01x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Atrium Health Navicent Rehabilitation Hopsital is $108. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $316. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.01x the Medicare baseline. Located in 3351 Northside Dr, Macon, GA.

Cash / Self-Pay

$316

Average discount available for prompt cash payment at this facility.

Insurance Median

$108

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: $316 (296%)

Insurance Median: $108 (101%)

Cash: $316 (296% of Medicare)

Ins. Median: $108 (101% 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
Aetna	$31 - $435	29%
Blue Cross Blue Shield	$31 - $106	29%
Care Source	$31 - $108	29%
Clover	$31 - $108	29%
Eon Health	$31 - $108	29%
Georgia Health Advantage	$31 - $106	29%
Humana	$31 - $434	29%
UnitedHealthcare	$31 - $939	29%
Pruitt Health	$32 - $106	30%
Alliant	$37 - $128	35%
Ambetter / Centene	$41 - $322	38%
Cigna	$76 - $308	71%
Securehealth	$81 - $221	76%
Kaiser	$101 - $410	95%
Ibg	$117 - $446	110%
Multiplan	$410 - $505	384%
Novanet	$505	473%
Three Rivers Provider Network	$536	502%
Beechstreet	$587	550%

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 $316.
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 Atrium Health Navicent Rehabilitation Hopsital 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.