CMS Price Transparency Data

Ultrasound, pelvis

Facility: Jacksonville Memorial Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $1,026
Cash Discount Price: $1,684
vs. Medicare Baseline: 9.61x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Jacksonville Memorial Hospital is $1,026. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,684. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 9.61x the Medicare baseline. Located in 1600 W Walnut St, Jacksonville, IL.

Cash / Self-Pay

$1,684

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,026

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: $1,684 (1577%)

Insurance Median: $1,026 (961%)

Cash: $1,684 (1577% of Medicare)

Ins. Median: $1,026 (961% 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 961% of the Medicare baseline (a markup of 861%). 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	$93 - $1,858	87%
Tricare	$95 - $339	89%
Coventry	$98 - $293	92%
Health Alliance	$98 - $1,263	92%
Humana	$98 - $1,585	92%
Medicare (plans)	$98 - $293	92%
UnitedHealthcare	$103 - $1,338	96%
Corvel/Corcare	$307 - $400	287%
Illinois Workers Compensation	$329 - $526	308%
Medicaid / KanCare	$330	309%
Molina Healthcare	$330	309%
Commercial Workers Compensation	$500	468%
Health Alliance Mh Employee Plan	$694 - $855	650%
Current Health Network	$830 - $1,394	777%
6 Degrees Health	$905 - $1,115	847%
Hope Trust	$905 - $1,115	847%
Hst	$905 - $1,115	847%
Cigna	$1,046 - $1,288	979%
Aetna	$1,055 - $1,486	988%
Healthlink	$1,283 - $1,579	1201%
Phcs/Multiplan	$1,358 - $1,672	1271%
Hfn	$1,434 - $1,765	1343%
Liability	$1,509 - $1,858	1413%

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 $1,684.
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 Jacksonville Memorial 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.