CMS Price Transparency Data

Ultrasound, pelvis

Facility: Pinckneyville Community Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $364
Cash Discount Price: $612
vs. Medicare Baseline: 3.41x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Pinckneyville Community Hospital is $364. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $612. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.41x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$612

Average discount available for prompt cash payment at this facility.

Insurance Median

$364

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: $612 (573%)

Insurance Median: $364 (341%)

Cash: $612 (573% of Medicare)

Ins. Median: $364 (341% 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 341% of the Medicare baseline (a markup of 241%). 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
Umwa Mcr Adv - All Plans	$32 - $364	30%
UnitedHealthcare	$32 - $806	30%
Wellcare Mcr Adv - All Plans	$32 - $364	30%
Aetna	$33 - $919	31%
Humana	$33 - $364	31%
Cigna	$39 - $811	37%
Blue Cross Blue Shield	$76 - $919	71%
Healthlink Hmo	$149 - $772	140%
Healthlink Ppo - All Other Plans	$149 - $811	140%
Ambetter / Centene	$186 - $919	174%
Medicaid / KanCare	$186 - $919	174%
Phcs Savility	$204 - $836	191%
Multiplan - All Plans	$216 - $885	202%
Phcs - All Other Plans	$216 - $806	202%
Healthlink Work Comp	$811	759%

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 $612.
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 Pinckneyville 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.