CMS Price Transparency Data

Ultrasound, pelvis

Facility: St Francis Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $962
Cash Discount Price: $945
vs. Medicare Baseline: 9.01x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at St Francis Hospital is $962. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $945. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 9.01x the Medicare baseline. Located in 1215 Franciscan Dr, Litchfield, IL.

Cash / Self-Pay

$945

Average discount available for prompt cash payment at this facility.

Insurance Median

$962

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: $945 (885%)

Insurance Median: $962 (901%)

Cash: $945 (885% of Medicare)

Ins. Median: $962 (901% 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 901% of the Medicare baseline (a markup of 801%). 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
Illinois Breast and Cervical Cancer Program	$72	67%
Wexford	$209	196%
Molina Healthcare	$219 - $290	205%
Meridian Health Plan	$230	215%
Blue Cross Blue Shield	$276 - $302	258%
Clear Spring Health of Illinois	$276	258%
Humana	$276	258%
UnitedHealthcare	$289 - $1,313	271%
Aetna	$289 - $923	271%
Amish Community	$368	345%
Celtic Insurance Company	$664	622%
Claim Doc	$689	645%
Hopetrust	$755	707%
Wellfirst	$845	791%
Cigna	$950	889%
First Health	$974	912%
Caterpillar, Inc.	$1,053	986%
Current Health Solutions	$1,103	1033%
Multiplan/Phcs	$1,116	1045%
Consociate Group	$1,116	1045%
Healthlink	$1,120	1049%
Provider Network of America	$1,182	1107%
Healthcare Finest Network (Hfn)	$1,182	1107%
Healthscope	$1,313	1229%
Interplan	$1,313	1229%
Health Alliance Medical Plans	$1,313	1229%
Live360	$1,313	1229%
Naphcare	$1,313	1229%

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 $945.
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 St Francis 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.