CMS Price Transparency Data

Ultrasound, pelvis

Facility: Rush Memorial Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $42
Cash Discount Price: $111
vs. Medicare Baseline: 0.39x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Rush Memorial Hospital is $42. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $111. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.39x the Medicare baseline. Located in 1300 N Main St, Rushville, IN.

Cash / Self-Pay

$111

Average discount available for prompt cash payment at this facility.

Insurance Median

$42

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: $111 (104%)

Insurance Median: $42 (39%)

Cash: $111 (104% of Medicare)

Ins. Median: $42 (39% 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
UnitedHealthcare	$27 - $31	25%
Aetna	$30 - $31	28%
Consumers Life Ins-All Plans	$30	28%
Humana	$30 - $31	28%
Caresource Mcr Adv	$31	29%
Blue Cross Blue Shield	$32 - $105	30%
Today'S Option Mcr Adv-All Plans	$32	30%
Viant Beech St Mcr Adv	$32	30%
My True Advantage - All Plans	$33	31%
Caresource Marketplace-All Other Plans	$42	39%
Multiplan-All Plans	$42	39%
Phcs-All Plans	$45	42%
Encore Health Services-All Plans	$53	50%
Siho-All Plans	$53	50%
Cigna	$74	69%
Health Net	$74	69%
Coventry/First Health-All Plans	$104	97%

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 $111.
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 Rush 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.