CMS Price Transparency Data

Ultrasound, pelvis

Facility: Cass County Memorial Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $235
Cash Discount Price: $384
vs. Medicare Baseline: 2.20x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Cass County Memorial Hospital is $235. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $384. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.20x the Medicare baseline. Located in 1501 East Tenth Street, Atlantic, IA.

Cash / Self-Pay

$384

Average discount available for prompt cash payment at this facility.

Insurance Median

$235

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: $384 (360%)

Insurance Median: $235 (220%)

Cash: $384 (360% of Medicare)

Ins. Median: $235 (220% 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 220% of the Medicare baseline (a markup of 120%). 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
Midlands Choice Medica Mcr	$110	103%
UnitedHealthcare	$151 - $230	141%
Triwest - All Plans	$223	209%
Aetna	$230 - $521	215%
Amerigroup Mcr Adv - All Other Plans	$230	215%
Medica Mcr Adv	$230	215%
Tricare	$230	215%
Va Ccn - All Plans	$230	215%
Wellmark Mcr Adv	$232	217%
Iowa Total Care Mcaid	$235	220%
Iowa Total Care Mcr	$235	220%
Molina Mcaid - All Plans	$235	220%
American Hlth Mcr Adv - All Plans	$237	222%
Medicaid / KanCare	$237	222%
Iowa Total Care Comm - All Other Plans	$253	237%
Midlands Choice New Bus	$356	333%
Wellmark Hmo	$395	370%
Wellmark Ppo - All Other Plans	$434	406%
Medica Comm - All Other Plans	$482	451%
Midlands Choice Pho (Ppo) - All Other Plans	$493	462%
Multiplan - All Plans	$521	488%

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 $384.
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 Cass County Memorial 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.