CMS Price Transparency Data

Ultrasound, pelvis

Facility: Hermann Area District Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $737
Cash Discount Price: $836
vs. Medicare Baseline: 6.90x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Hermann Area District Hospital is $737. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $836. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 6.90x the Medicare baseline. Located in 509 W 18Th St, Hermann, MO.

Cash / Self-Pay

$836

Average discount available for prompt cash payment at this facility.

Insurance Median

$737

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: $836 (783%)

Insurance Median: $737 (690%)

Cash: $836 (783% of Medicare)

Ins. Median: $737 (690% 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 690% of the Medicare baseline (a markup of 590%). 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
Healthy Blue Mcaid - All Plans	$70	66%
Ambetter / Centene	$73 - $1,330	68%
Blue Cross Blue Shield	$76 - $1,538	71%
UnitedHealthcare	$76 - $793	71%
Tricare	$356 - $748	333%
Choicecare Mcr Adv- All Plans	$377 - $793	353%
American Hlth Mcr Adv- All Plans	$395 - $831	370%
Humana	$395 - $831	370%
Aetna	$403 - $1,795	377%
Wellcare Mcr Adv - All Plans	$403 - $848	377%
Harmony Hp Mcaid- All Plans	$521 - $1,096	488%
Cigna	$533 - $1,122	499%
Care Partners Mcaid- All Plans	$539 - $562	505%
Healthcare Usa Mcaid- All Plans	$584 - $1,228	547%
Healthlink Hmo	$584 - $1,228	547%
Healthlink Ppo - All Other Plans	$674 - $1,417	631%
Multiplan/Phcs - All Plans	$674 - $1,417	631%
Coventry - All Plans	$763 - $1,606	714%
Comp Results - All Plans	$808 - $1,700	756%
Three Rivers - All Plans	$808 - $1,700	756%

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 $836.
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 Hermann Area District 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.