CMS Price Transparency Data

Ultrasound, pelvis

Facility: Novant Health Forsyth Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $592
Cash Discount Price: $574
vs. Medicare Baseline: 5.54x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Novant Health Forsyth Medical Center is $592. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $574. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.54x the Medicare baseline. Located in 3333 Silas Creek Parkway, Winston-Salem, NC.

Cash / Self-Pay

$574

Average discount available for prompt cash payment at this facility.

Insurance Median

$592

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: $574 (537%)

Insurance Median: $592 (554%)

Cash: $574 (537% of Medicare)

Ins. Median: $592 (554% 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 554% of the Medicare baseline (a markup of 454%). 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	$101 - $782	95%
Humana	$101 - $887	95%
Pace Of The Southern Piedmont	$101	95%
UnitedHealthcare	$101 - $767	95%
Aetna	$104 - $911	97%
Cigna	$104 - $677	97%
Liberty Health	$106	99%
Carolina Complete	$174 - $212	163%
Nc Department Of Public Safety	$174 - $212	163%
Amerihealth	$177 - $216	166%
Wellcare	$177 - $216	166%
Caresource North Carolina	$374 - $456	350%
Atlantic Corporation Dba Atlantic Packaging	$529 - $644	495%
Plotkin Health	$562 - $683	526%
Amps	$608 - $740	569%
Medcost	$796 - $1,071	745%
Primary Physician Care	$824 - $1,002	771%
Beechstreet	$842 - $1,025	788%
Multiplan	$842 - $1,025	788%
Phcs	$842 - $1,025	788%
Employers Choice Network	$908 - $1,105	850%
Three Rivers Provider Network	$908 - $1,105	850%

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 $574.
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 Novant Health Forsyth 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.