CMS Price Transparency Data

Ultrasound, pelvis

Facility: Phelps Memorial Health Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $779
Cash Discount Price: $877
vs. Medicare Baseline: 7.29x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Phelps Memorial Health Center is $779. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $877. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 7.29x the Medicare baseline. Located in 1215 Tibbals St, Holdrege, NE.

Cash / Self-Pay

$877

Average discount available for prompt cash payment at this facility.

Insurance Median

$779

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: $877 (821%)

Insurance Median: $779 (729%)

Cash: $877 (821% of Medicare)

Ins. Median: $779 (729% 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 729% of the Medicare baseline (a markup of 629%). 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
UnitedHealthcare	$399 - $945	374%
Aetna	$419 - $898	392%
Blue Cross Blue Shield	$419 - $925	392%
Good Samaritan Mcr Adv - All Plans	$419	392%
Medica Mcr Adv	$419	392%
Va Ccn - All Plans	$419	392%
Wellcare Mcr Adv - All Plans	$419	392%
Molina Mcaid - All Plans	$429	402%
Three Rivers - All Plans	$503	471%
6 Degrees Hlth - All Plans	$779	729%
Partners Hlth Alliance - All Plans	$779	729%
Cpi Benefit Group-All Plans	$877	821%
Providrs Care/Wppa - All Plans	$877	821%
Provider Network Of American - All Plans	$906	848%
Medica-All Other Plans	$916	858%
Chi Health Partners - All Plans	$925	866%
Midwest Ntwrk Alliance - All Plans	$925	866%
First Health - All Plans	$926	867%
Ambetter / Centene	$1,089	1020%

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 $877.
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 Phelps Memorial Health 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.