CMS Price Transparency Data

Ultrasound, pelvis

Facility: McDowell Arh Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $264
Cash Discount Price: $919
vs. Medicare Baseline: 2.47x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at McDowell Arh Hospital is $264. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $919. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.47x the Medicare baseline. Located in 9879 Kentucky Route 122, Mc Dowell, KY.

Cash / Self-Pay

$919

Average discount available for prompt cash payment at this facility.

Insurance Median

$264

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: $919 (860%)

Insurance Median: $264 (247%)

Cash: $919 (860% of Medicare)

Ins. Median: $264 (247% 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 247% of the Medicare baseline (a markup of 147%). 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
Aetna	$260 - $1,347	243%
Blue Cross Blue Shield	$260 - $1,339	243%
Humana	$260	243%
UnitedHealthcare	$260 - $1,139	243%
Wellcare Of Kentucky	$260 - $263	243%
Passport Molina	$265	248%
Caresoure Kentucky	$995	932%

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 $919.
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 McDowell Arh 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.