CMS Price Transparency Data

Ultrasound, pelvis

Facility: Wabash General Hospital 1

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $590
Cash Discount Price: $786
vs. Medicare Baseline: 5.52x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Wabash General Hospital 1 is $590. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $786. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.52x the Medicare baseline. Located in 1418 College Drive, Mount Carmel, IL.

Cash / Self-Pay

$786

Average discount available for prompt cash payment at this facility.

Insurance Median

$590

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: $786 (736%)

Insurance Median: $590 (552%)

Cash: $786 (736% of Medicare)

Ins. Median: $590 (552% 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 552% of the Medicare baseline (a markup of 452%). 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
Blue Cross Blue Shield	$232 - $684	217%
UnitedHealthcare	$244 - $629	228%
Health Alliance Mcr Adv - All Plans	$249	233%
Aetna	$407 - $669	381%
Meridian Mcaid - All Plans	$407	381%
Molina Mcaid - All Plans	$407	381%
Healthlink Hmo	$551	516%
Cigna	$590	552%
Encore Combined Ip/Op Only	$590	552%
Hope Trust - All Plans	$590	552%
Healthlink Ppo - All Other Plans	$629	589%
Phcs - All Plans	$629	589%
Health Smart - All Plans	$669	626%
Hfn - All Plans	$669	626%
Multiplan - All Plans	$669	626%
Siho Network - All Plans	$669	626%
Encore Health Network Ip/Op Only - All Other Plans	$708	663%

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 $786.
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 Wabash General Hospital 1 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.