CMS Price Transparency Data

Ultrasound, pelvis

Facility: Atrium Health Pineville

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $193
Cash Discount Price: $644
vs. Medicare Baseline: 1.81x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Atrium Health Pineville is $193. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $644. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.81x the Medicare baseline. Located in 10628 Park Rd, Charlotte, NC.

Cash / Self-Pay

$644

Average discount available for prompt cash payment at this facility.

Insurance Median

$193

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: $644 (603%)

Insurance Median: $193 (181%)

Cash: $644 (603% of Medicare)

Ins. Median: $193 (181% 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.

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
Trillium	$28 - $137	26%
Alliance	$29 - $136	27%
Amerihealth Caritas	$29 - $131	27%
Carolina Complete Health	$29 - $133	27%
Healthy Blue	$29 - $133	27%
Partners	$29 - $129	27%
UnitedHealthcare	$29 - $606	27%
Vaya	$29 - $134	27%
Wellcare	$29 - $133	27%
Cigna	$30 - $869	28%
Humana	$31 - $103	29%
Aetna	$32 - $1,069	30%
Ortho Carolina	$38 - $126	36%
Blue Cross Blue Shield	$63 - $501	59%
Choicecare	$66 - $953	62%
Medcost	$88 - $770	82%
Ambetter / Centene	$374 - $467	350%
Employers Health Network	$569	533%
Physician Reach Out	$644	603%
Magellan	$773	724%
Gmmi	$837	784%
Quik Trip	$837	784%
Healthgram	$1,030	964%
Provider Select	$1,043 - $1,159	977%
Private Health Care Systems	$1,056	989%
First Health	$1,069	1001%
Beechstreet	$1,159	1085%
Multiplan	$1,185	1109%

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 $644.
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 Atrium Health Pineville 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.