CMS Price Transparency Data

Ultrasound, pelvis

Facility: Mc Donough District Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 76856
  • Insurance Median: $176
  • Cash Discount Price: $402
  • vs. Medicare Baseline: 1.65x Medicare
The contracted insurance negotiated median rate for a Ultrasound, pelvis at Mc Donough District Hospital is $176. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $402. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.65x the Medicare baseline. Located in 525 East Grant Street, Macomb, IL.
Cash / Self-Pay
$402

Average discount available for prompt cash payment at this facility.

Insurance Median
$176

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: $402 (376%)
Insurance Median: $176 (165%)
Cash: $402 (376% of Medicare)
Ins. Median: $176 (165% 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.

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
Health Alliance $19 - $1,019 18%
Hfn $30 - $1,030 28%
UnitedHealthcare $30 - $1,030 28%
Aetna $31 - $1,145 29%
Humana $31 - $1,030 29%
Medicaid / KanCare $31 - $1,145 29%
Medicare (plans) $31 - $119 29%
Meridian $31 - $119 29%
Molina $31 - $1,145 29%
Mutual Medical $31 - $1,145 29%
Veteran Affairs $31 - $119 29%
Tricare $111 104%
Springfield Health $161 - $939 151%
Consociate $167 - $973 156%
Trilogy $167 - $973 156%
Blue Choice $176 - $1,030 165%
Current Health $176 - $1,030 165%
Healthlink $176 - $1,076 165%
Preferred Plan $186 - $1,088 174%
Blue Cross Blue Shield $196 - $1,145 184%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 525 East Grant Street, Macomb, IL 61455
  • CMS Rating: ★★★☆☆
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Acute Care Hospitals