CMS Price Transparency Data

Ultrasound, pelvis

Facility: Memorial Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $1,115
Cash Discount Price: $1,858
vs. Medicare Baseline: 10.44x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Memorial Medical Center is $1,115. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,858. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 10.44x the Medicare baseline. Located in 701 N First St, Springfield, IL.

Cash / Self-Pay

$1,858

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,115

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: $1,858 (1740%)

Insurance Median: $1,115 (1044%)

Cash: $1,858 (1740% of Medicare)

Ins. Median: $1,115 (1044% 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 1044% of the Medicare baseline (a markup of 944%). 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
Veterans Administration	$79	74%
Blue Cross Blue Shield	$98 - $1,858	92%
Aetna	$110 - $1,412	103%
Health Alliance	$110 - $1,208	103%
Medicare (plans)	$110 - $1,858	103%
Tricare	$110	103%
UnitedHealthcare	$110 - $1,152	103%
Humana	$116 - $1,115	109%
Healthlink	$157 - $1,171	147%
Medicaid / KanCare	$211	198%
Molina	$216	202%
Commercial Workers Compensation	$442	414%
Illinois Workers Compensation	$465	435%
Current Health Network Ppo	$836	783%
Cigna	$975	913%
Phcs/Multiplan	$1,003 - $1,115	939%
6 Degrees Health	$1,115	1044%
Hopetrust	$1,115	1044%
Hst	$1,115	1044%
Magellan	$1,115	1044%
Consociate	$1,208	1131%
Hfn	$1,208	1131%
Preferred Plan	$1,394	1305%
Soi Mcfarland	$1,394	1305%
Soi Rushville	$1,394	1305%
Corvel	$1,486	1391%
Methodist First Choice	$1,486	1391%
Mutual Medical Plans	$1,579	1478%
Liability	$1,858	1740%

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 $1,858.
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 Memorial Medical Center 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.