CMS Price Transparency Data

Ultrasound, pelvis

Facility: Decatur Memorial Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $434
Cash Discount Price: $1,784
vs. Medicare Baseline: 4.06x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Decatur Memorial Hospital is $434. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,784. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.06x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$1,784

Average discount available for prompt cash payment at this facility.

Insurance Median

$434

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: $1,784 (1670%)

Insurance Median: $434 (406%)

Cash: $1,784 (1670% of Medicare)

Ins. Median: $434 (406% 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 406% of the Medicare baseline (a markup of 306%). 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
Aetna	$98 - $1,197	92%
Blue Cross Blue Shield	$98 - $1,784	92%
Coventry	$98 - $904	92%
Health Alliance	$98 - $1,186	92%
Humana	$98 - $1,160	92%
Medicare (plans)	$98 - $110	92%
UnitedHealthcare	$98 - $1,784	92%
Veterans Administration	$98 - $110	92%
Tricare	$100 - $112	94%
Wellcare	$110	103%
Plain Church Medical Group	$136 - $803	127%
Medicaid / KanCare	$211 - $216	198%
Caterpillar	$252	236%
Illinois Workers Compensation	$329 - $417	308%
Hfn	$392 - $1,338	367%
Commercial Workers Compensation	$396	371%
Mennonite Churches	$624	584%
Health Alliance Mh Employee Plan	$821	769%
Cigna	$831	778%
6 Degrees Health	$1,070	1002%
Hopetrust	$1,070	1002%
Hst	$1,070	1002%
Phcs Savility	$1,160	1086%
Phcs Multiplan Ppo	$1,213	1136%
Healthlink	$1,224	1146%
Corvel	$1,284	1202%
Consociate	$1,320	1236%
Liability	$1,784	1670%

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 $1,784.
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 Decatur 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.