CMS Price Transparency Data

Ultrasound, pelvis

Facility: Pulaski Memorial Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $95
Cash Discount Price: $492
vs. Medicare Baseline: 0.89x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Pulaski Memorial Hospital is $95. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $492. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.89x the Medicare baseline. Located in 616 E 13Th St, Winamac, IN.

Cash / Self-Pay

$492

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: $492 (461%)

Insurance Median: $95 (89%)

Cash: $492 (461% 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
UnitedHealthcare	$29 - $1,035	27%
Mdwise Mcaid Hcc	$30 - $63	28%
Mdwise Mcaid Hhw	$30 - $63	28%
Mdwise Mcaid Hip - All Other Plans	$30 - $406	28%
Ambetter / Centene	$31 - $406	29%
Blue Cross Blue Shield	$31 - $871	29%
Caresource Mcaid Hip	$31 - $406	29%
Caresource Mcare Hmo	$31 - $406	29%
Cenpatico Mcaid Hip	$31 - $406	29%
Humana	$31 - $1,053	29%
Mhs Mcaid Hip	$31 - $406	29%
Mhs Mcare Allwell	$31 - $410	29%
Multiplan - All Plans	$31 - $1,179	29%
Caresource Exch Hmo Hix - All Other Plans	$39 - $508	37%
Encore Ppo - All Other Plans	$47 - $1,114	44%
Cigna	$53 - $1,245	50%
Sagamore - All Other Plans	$53 - $991	50%
Sagamore Rose Acre	$53 - $976	50%
Community Health Alliance - All Plans	$61 - $1,166	57%
Caresource Mcaid Hhw	$63 - $95	59%
Cenpatico Mcaid Hhw - All Other Plans	$63 - $95	59%
Mhs Mcaid Hhw/Hcc	$63 - $95	59%
Encore Workers Comp	$86 - $1,179	81%
Aetna	$472	442%

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 $492.
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 Pulaski 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.