CMS Price Transparency Data

Ultrasound, pelvis

Facility: Norton Scott Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $645
Cash Discount Price: $229
vs. Medicare Baseline: 6.04x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Norton Scott Hospital is $645. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $229. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 6.04x the Medicare baseline. Located in 1451 N Gardner St, Scottsburg, IN.

Cash / Self-Pay

$229

Average discount available for prompt cash payment at this facility.

Insurance Median

$645

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: $229 (214%)

Insurance Median: $645 (604%)

Cash: $229 (214% of Medicare)

Ins. Median: $645 (604% 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 604% of the Medicare baseline (a markup of 504%). 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
Caresource Indiana Healthy Indiana Plan (Hip)	$63	59%
Caresource Indiana Hoosier Healthwise (Hhw)	$63	59%
Managed Health Services (Mhs)	$63 - $275	59%
Managed Health Services (Mhs) Hoosier Care Connect	$63	59%
UnitedHealthcare	$63 - $684	59%
Mdwise Hoosier Healthwise (Hhw)	$66	62%
Molina Healthcare	$110 - $113	103%
Blue Cross Blue Shield	$252 - $673	236%
Managed Health Services (Mhs) Healthy Indiana Plan (Hip)	$275	257%
Mdwise Healthy Indiana Plan (Hip)	$275	257%
Communicare Advantage	$284	266%
Caresource Indiana Just4Me	$413	387%
Aetna	$723	677%
Multiplan	$918 - $975	859%
Cigna	$975	913%
Encore Health Network	$975	913%
Prime Health	$975	913%
Ppom	$1,009	945%
Intercommunity Health Network (Ihn)	$1,032	966%

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 $229.
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 Norton Scott 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.