CMS Price Transparency Data

Ultrasound, pelvis

Facility: Methodist Jennie Edmundson

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $384
Cash Discount Price: $256
vs. Medicare Baseline: 3.60x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Methodist Jennie Edmundson is $384. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $256. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.60x the Medicare baseline. Located in 933 East Pierce Street, Council Bluffs, IA.

Cash / Self-Pay

$256

Average discount available for prompt cash payment at this facility.

Insurance Median

$384

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: $256 (240%)

Insurance Median: $384 (360%)

Cash: $256 (240% of Medicare)

Ins. Median: $384 (360% 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 360% of the Medicare baseline (a markup of 260%). 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
Medicare (plans)	$97 - $428	91%
Aetna	$105 - $513	98%
Humana	$105	98%
Blue Cross Blue Shield	$107 - $556	100%
Medica	$107 - $385	100%
UnitedHealthcare	$107 - $513	100%
Elite Choice - Mje	$186 - $218	174%
Ambetter / Centene	$203 - $221	190%
Midlands Choice	$246 - $598	230%
Wellmark	$327 - $359	306%
Ne Furniture Mart	$393 - $513	368%
Medica Choice	$427 - $428	400%

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 $256.
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 Methodist Jennie Edmundson 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.