CMS Price Transparency Data

Ultrasound, pelvis

Facility: Jones Memorial Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $119
Cash Discount Price: $202
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Jones Memorial Hospital is $119. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $202. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.11x the Medicare baseline. Located in 191 North Main Street, Wellsville, NY.

Cash / Self-Pay

$202

Average discount available for prompt cash payment at this facility.

Insurance Median

$119

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: $202 (189%)

Insurance Median: $119 (111%)

Cash: $202 (189% of Medicare)

Ins. Median: $119 (111% 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
Blue Cross Blue Shield	$33 - $273	31%
Fidelis 5155	$33 - $56	31%
Medicaid / KanCare	$33 - $125	31%
UnitedHealthcare	$33 - $140	31%
Univera Healthcare 1706	$33 - $56	31%
Molina Healthcare 1723	$61 - $125	57%
UPMC Health Plan 5138	$105	98%
Humana	$140	131%
Medicare (plans)	$140 - $203	131%
Total Senior Care 1319	$140	131%
Mvp 2900	$147 - $330	138%
Aetna	$148 - $382	139%
Independent Health 5156	$203	190%
Empire Plan 5179	$247	231%
Cigna	$342	320%

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 $202.
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 Jones Memorial Hospital 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.