CMS Price Transparency Data

Ultrasound, pelvis

Facility: Elkhart General Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $428
Cash Discount Price: $464
vs. Medicare Baseline: 4.01x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Elkhart General Hospital is $428. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $464. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.01x the Medicare baseline. Located in 600 E Blvd, Elkhart, IN.

Cash / Self-Pay

$464

Average discount available for prompt cash payment at this facility.

Insurance Median

$428

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: $464 (434%)

Insurance Median: $428 (401%)

Cash: $464 (434% of Medicare)

Ins. Median: $428 (401% 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 401% of the Medicare baseline (a markup of 301%). 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
Mclaren (Mi	$60	56%
UnitedHealthcare	$60 - $480	56%
Aetna	$111 - $483	104%
Blue Cross Blue Shield	$111 - $332	104%
Humana	$111 - $500	104%
Pace	$111	104%
Devoted Healthcare	$117 - $143	110%
Plain Church	$167 - $571	156%
Caresource	$178 - $928	167%
Mhs	$201 - $928	188%
Mdwise	$245 - $928	229%
Cha	$428 - $557	401%
Immergrun	$428 - $571	401%
Php	$464 - $500	434%
Cigna	$514 - $543	481%
Multiplan	$514	481%
Signature	$521	488%
Encore	$528	494%
Heartland	$714	668%

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 $464.
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 Elkhart General 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.