CMS Price Transparency Data

Ultrasound, pelvis

Facility: Methodist Hospitals Inc

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $325
Cash Discount Price: $755
vs. Medicare Baseline: 3.04x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Methodist Hospitals Inc is $325. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $755. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 3.04x the Medicare baseline. Located in 600 Grant St, Gary, IN.

Cash / Self-Pay

$755

Average discount available for prompt cash payment at this facility.

Insurance Median

$325

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: $755 (707%)

Insurance Median: $325 (304%)

Cash: $755 (707% of Medicare)

Ins. Median: $325 (304% 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 304% of the Medicare baseline (a markup of 204%). 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	$110 - $798	103%
Blue Cross Blue Shield	$110 - $954	103%
Humana	$110 - $245	103%
Medicare (plans)	$110	103%
United Heathcare	$110	103%
Zing	$112	105%
Caresource Maketplace	$182	170%
Ambetter / Centene	$220	206%
Caresource	$245	229%
Managed Health Services	$245	229%
Medicaid / KanCare	$245	229%
UnitedHealthcare	$245 - $384	229%
Cigna	$414 - $450	388%
Magnacare	$523	490%
Physicians Health Plan Of Northern Indiana	$624	584%
Encore	$647 - $960	606%
Phcs	$734	687%
Siho	$755	707%
Sagamore	$777	727%
Multiplan	$788	738%
Hfn	$842 - $917	788%

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 $755.
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 Methodist Hospitals Inc 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.