CMS Price Transparency Data

Ultrasound, pelvis

Facility: Fayette County Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $332
Cash Discount Price: $905
vs. Medicare Baseline: 3.11x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Fayette County Hospital is $332. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $905. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.11x the Medicare baseline. Located in 650 W Taylor St, Vandalia, IL.

Cash / Self-Pay

$905

Average discount available for prompt cash payment at this facility.

Insurance Median

$332

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: $905 (847%)

Insurance Median: $332 (311%)

Cash: $905 (847% of Medicare)

Ins. Median: $332 (311% 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 311% of the Medicare baseline (a markup of 211%). 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	$29 - $1,121	27%
Health Alliance Mcare	$32 - $520	30%
Healthlink Mcr Adv	$32 - $520	30%
Cigna	$37 - $1,218	35%
Coventry/Ghp-All Plans	$44 - $1,056	41%
Multiplan - All Plans	$60 - $1,380	56%
Health Alliance - All Other Plans	$65 - $1,341	61%
Blue Cross Blue Shield	$76 - $1,364	71%
UnitedHealthcare	$154 - $1,348	144%
Healthlink Hmo	$160 - $1,137	150%
Healthlink Ppo - All Other Plans	$160 - $1,299	150%
Illinicare - All Plans	$186 - $332	174%
Medicaid / KanCare	$186 - $332	174%
Meridian-All Plans	$186 - $332	174%
Humana	$520	487%

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 $905.
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 Fayette County 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.