CMS Price Transparency Data

Ultrasound, pelvis

Facility: Salem Memorial District Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 76856
  • Insurance Median: $760
  • Cash Discount Price: $713
  • vs. Medicare Baseline: 7.12x Medicare
The contracted insurance negotiated median rate for a Ultrasound, pelvis at Salem Memorial District Hospital is $760. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $713. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.12x the Medicare baseline. Located in Po Box 774, Salem, MO.
Cash / Self-Pay
$713

Average discount available for prompt cash payment at this facility.

Insurance Median
$760

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: $713 (668%)
Insurance Median: $760 (712%)
Cash: $713 (668% of Medicare)
Ins. Median: $760 (712% 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 712% of the Medicare baseline (a markup of 612%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 $323 - $855 302%
Ambetter / Centene $323 302%
Blue Cross Blue Shield $323 - $903 302%
Humana $323 - $808 302%
Tricare $323 302%
Triwest $323 302%
UnitedHealthcare $323 302%
Veteran'S Affairs $323 302%
Healthlink $618 579%
First Health $760 712%
Mercy - C.B. Management Company/Joplin Supply Company $760 712%
Mercy - City Of Springfield $760 712%
Mercy - Clayco $760 712%
Mercy - Commerce Bank $760 712%
Mercy - Diversified Plastics $760 712%
Mercy - Employers Benefit Alliance $760 712%
Mercy - Evolutions $760 712%
Mercy - Fabick Cat $760 712%
Mercy - Firsthealth Network $760 712%
Mercy - Health Management Network $760 712%
Mercy - Health Systems Inc $760 712%
Mercy - Liberty Utilities/Empire District Electric $760 712%
Mercy - Life Church $760 712%
Mercy - Missouri State University $760 712%
Mercy - Prime Health Services $760 712%
Mercy - Quiktrip Corporation $760 712%
Mercy - Shinesolar $760 712%
Mercy - Springfield Public Schools $760 712%
Mercy - Springfield Remanufacturing $760 712%
Mercy - Sumnerone $760 712%
Mercy - Trailiner $760 712%
Mercy - Walmart Mercy Accountable Care Plan $760 712%
Mercy-American Healthcare Alliance $760 712%
Phcs $760 - $808 712%
Cigna $807 756%
Mercy - Compresults $855 800%
Mercy - Corvel Corporation $855 800%
Mercy - Novasys $855 800%
Mercy - Scurlock Industries $855 800%
Mercy - Usa Managed Care Organization $855 800%
Right Choice-Alliance $903 845%
Right Choice-Regular $922 863%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: Po Box 774, Salem, MO 65560
  • CMS Rating: ★★★★☆
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Critical Access Hospitals