CMS Price Transparency Data

Ultrasound, pelvis

Facility: Perry County Memorial Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $568
Cash Discount Price: $676
vs. Medicare Baseline: 5.32x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Perry County Memorial Hospital is $568. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $676. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.32x the Medicare baseline. Located in 8885 Sr 237, Tell City, IN.

Cash / Self-Pay

$676

Average discount available for prompt cash payment at this facility.

Insurance Median

$568

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: $676 (633%)

Insurance Median: $568 (532%)

Cash: $676 (633% of Medicare)

Ins. Median: $568 (532% 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 532% of the Medicare baseline (a markup of 432%). 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
Medicaid / KanCare	$222 - $966	208%
Veterans Administration	$242 - $966	227%
Bc 130	$251 - $772	235%
Group Insurance	$251 - $966	235%
Medicare (plans)	$251	235%
Workers Compensation	$483	452%
Nsa	$568 - $596	532%
Guarantor Liable	$676 - $966	633%
Pcmh Insurnace	$753 - $966	705%
Secondary Insurance	$772	723%
UnitedHealthcare	$772	723%
Operating Engineers	$821	769%
Boilermakers Healthcare	$840	786%
Cigna	$840	786%
Great West	$840 - $966	786%
Sagxxxx	$840	786%
Champus	$966	904%
Ngs American, Inc	$966	904%
Patoka Valley	$966	904%
Southwire	$966	904%
Tricare	$966	904%
Wausau Benefits	$966	904%

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 $676.
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 Perry County 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.