CMS Price Transparency Data

Ultrasound, pelvis

Facility: Boundary Community Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $96
Cash Discount Price: $224
vs. Medicare Baseline: 0.90x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Boundary Community Hospital is $96. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $224. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.90x the Medicare baseline. Located in 6640 Kaniksu Street, Bonners Ferry, ID.

Cash / Self-Pay

$224

Average discount available for prompt cash payment at this facility.

Insurance Median

$96

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: $224 (210%)

Insurance Median: $96 (90%)

Cash: $224 (210% of Medicare)

Ins. Median: $96 (90% 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
UnitedHealthcare	$22 - $403	21%
Molina Comm/Mrketplce - All Other Plans	$31 - $107	29%
Molina Mcr Adv	$31 - $261	29%
Cigna	$48 - $1,287	45%
Bc Idaho Qhp	$55 - $446	51%
Bc Idaho Comm - All Other Plans	$62 - $447	58%
Regence Blue Shield - All Plans	$66 - $1,837	62%
Molina Mcaid	$81 - $284	76%
Pacificsource Comm - All Other Plans	$83 - $460	78%
Aetna	$86 - $308	81%

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 $224.
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 Boundary Community 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.