CMS Price Transparency Data

Ultrasound, pelvis

Facility: Memorial Hospital and Health Care Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $95
Cash Discount Price: $80
vs. Medicare Baseline: 0.89x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Memorial Hospital and Health Care Center is $95. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $80. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.89x the Medicare baseline. Located in 800 W 9Th St, Jasper, IN.

Cash / Self-Pay

$80

Average discount available for prompt cash payment at this facility.

Insurance Median

$95

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: $80 (75%)

Insurance Median: $95 (89%)

Cash: $80 (75% of Medicare)

Ins. Median: $95 (89% 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.

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	$25 - $111	23%
Aetna	$30 - $169	28%
Caresource In Marketplace	$30 - $139	28%
Humana	$30 - $111	28%
Mdwise	$30 - $97	28%
Mhs Hoosier Care Connect	$30 - $97	28%
Tricare	$30 - $95	28%
Chamber Care	$31	29%
UnitedHealthcare	$35 - $334	33%
Immergrun	$36 - $114	34%
Ambetter / Centene	$39 - $145	37%
Onecare	$39 - $123	37%
Siho	$39 - $123	37%
Noncontracted	$48 - $178	45%
Cigna	$53 - $169	50%
Encore	$53 - $136	50%
Encore Elite +	$53 - $267	50%
Patoka Valley	$53 - $155	50%
Sagamore	$53 - $169	50%

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 $80.
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 Memorial Hospital and Health Care Center 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.