CMS Price Transparency Data

Ultrasound, pelvis

Facility: Holmes County Hospital and Clinics

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 76856
  • Insurance Median: $462
  • Cash Discount Price: $247
  • vs. Medicare Baseline: 4.33x Medicare
The contracted insurance negotiated median rate for a Ultrasound, pelvis at Holmes County Hospital and Clinics is $462. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $247. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.33x the Medicare baseline. Located in 239 Bowling Green Road, Lexington, MS.
Cash / Self-Pay
$247

Average discount available for prompt cash payment at this facility.

Insurance Median
$462

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: $247 (231%)
Insurance Median: $462 (433%)
Cash: $247 (231% of Medicare)
Ins. Median: $462 (433% 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 433% of the Medicare baseline (a markup of 333%). 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
Ms-Can-Molina-Lex $83 78%
Ms-Can-Magnolia-Lex $84 79%
Ms-Can-Truecare-Lex $85 80%
Molina-Chip-Lex $178 167%
Magnolia-Chip-Lex $182 170%
Truecare-Chip-Lex $182 170%
Advhealth-Lex $242 227%
Blue Cross Blue Shield $355 332%
Cigna $358 335%
Tricare $379 355%
Humana $386 361%
Mpcn-Lex $402 376%
Medadv_Uhc-Lex $420 393%
Firstchoice-Lex $433 405%
United-Lex $461 432%
Ambetter / Centene $464 434%
Medadv_Primewell-Lex $464 434%
Medicare (plans) $464 434%
Primewell-Lex $464 434%
United-Options-Lex $464 434%
Va_Ccn-Lex $464 434%
Medadv_Uhcdsnp-Lex $477 447%
Wellcare-Lex $477 447%
Ppoplus $482 451%
Devoted_Health-Lex $487 456%
Firsthealth-Lex $494 463%
Multiplan-Lex $494 463%
Aetna $525 492%
Phcs-Lex $556 521%
Molina_Exchange-Lex $618 579%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 239 Bowling Green Road, Lexington, MS 39095
  • CMS Rating: No CMS Rating
  • Ownership Type: Government - State
  • Hospital Type: Critical Access Hospitals