CMS Price Transparency Data

Ultrasound, pelvis

Facility: Kirby Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $124
Cash Discount Price: $660
vs. Medicare Baseline: 1.16x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Kirby Medical Center is $124. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $660. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.16x the Medicare baseline. Located in 1000 Medical Center Drive, Monticello, IL.

Cash / Self-Pay

$660

Average discount available for prompt cash payment at this facility.

Insurance Median

$124

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: $660 (618%)

Insurance Median: $124 (116%)

Cash: $660 (618% of Medicare)

Ins. Median: $124 (116% 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
Blue Cross Blue Shield	$26 - $1,078	24%
UnitedHealthcare	$31 - $758	29%
Aetna	$32 - $770	30%
Meridian	$32 - $341	30%
Wellcare	$32 - $341	30%
Molina	$33 - $351	31%
Zelis (Hfn)	$40 - $990	37%
Catepillar, Inc.	$65 - $935	61%
Humana	$133 - $825	125%
Healthlink	$292 - $990	273%
Multiplan/Phcs	$292 - $1,045	273%
Cigna	$880	824%

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 $660.
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 Kirby 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.