CMS Price Transparency Data

Ultrasound, pelvis

Facility: Monroe County Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $569
Cash Discount Price: $763
vs. Medicare Baseline: 5.33x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Monroe County Hospital is $569. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $763. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.33x the Medicare baseline. Located in 6580 165Th Street, Albia, IA.

Cash / Self-Pay

$763

Average discount available for prompt cash payment at this facility.

Insurance Median

$569

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: $763 (714%)

Insurance Median: $569 (533%)

Cash: $763 (714% of Medicare)

Ins. Median: $569 (533% 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 533% of the Medicare baseline (a markup of 433%). 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
Wellmark Hmo	$217	203%
Wellmark Ppo - All Other Plans	$233	218%
Mahp Mcare - All Plans	$259 - $566	242%
Tricare	$259 - $566	242%
UnitedHealthcare	$259 - $1,281	242%
Va Ccn - All Plans	$259 - $566	242%
Amerigroup Mcare	$262 - $572	245%
Humana	$262 - $572	245%
Wellmark Mcare	$262 - $572	245%
Aetna	$264 - $1,267	247%
Iowa Total Care Mcaid - All Plans	$308 - $674	288%
Molina Mcaid - All Plans	$313 - $684	293%
Amerigroup Mcaid - All Other Plans	$317 - $694	297%
Centivo - All Plans	$389 - $849	364%
Midlands Choice - All Plans	$432 - $944	404%
Preferred Hlth - All Plans	$463 - $1,011	433%
Geha - All Plans	$494 - $1,078	463%
Multiplan - All Plans	$555 - $1,213	520%
Integrated Hp - All Plans	$598 - $1,308	560%

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 $763.
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 Monroe County 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.