CMS Price Transparency Data

Ultrasound, pelvis

Facility: Central Montana Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $304
Cash Discount Price: $379
vs. Medicare Baseline: 2.85x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Central Montana Medical Center is $304. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $379. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.85x the Medicare baseline. Located in 408 Wendell Ave, Lewistown, MT.

Cash / Self-Pay

$379

Average discount available for prompt cash payment at this facility.

Insurance Median

$304

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: $379 (355%)

Insurance Median: $304 (285%)

Cash: $379 (355% of Medicare)

Ins. Median: $304 (285% 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 285% of the Medicare baseline (a markup of 185%). 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
Blue Cross Blue Shield	$31 - $697	29%
Humana	$31 - $418	29%
Triwest - All Plans	$31 - $410	29%
Veterans Affairs - All Plans	$31 - $410	29%
Montana Health Co-Op - All Plans	$53 - $751	50%
Allegiance Comm - All Other Plans	$55 - $744	51%
Allegiance Rbphp	$55 - $1,402	51%
Health Infonet - All Plans	$56 - $744	52%
Ebms - All Plans	$58 - $736	54%
Coventry/First Health - All Plans	$720	674%
UnitedHealthcare	$720	674%
Interwest Ppo	$759	711%
Pacific Source Hp - All Plans	$759	711%
Interwest Trad - All Other Plans	$774	725%

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 $379.
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 Central Montana Medical Center 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.