CMS Price Transparency Data

Ultrasound, pelvis

Facility: Bertrand Chaffee Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $79
Cash Discount Price: $77
vs. Medicare Baseline: 0.74x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Bertrand Chaffee Hospital is $79. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $77. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.74x the Medicare baseline. Located in 224 East Main Street, Springville, NY.

Cash / Self-Pay

$77

Average discount available for prompt cash payment at this facility.

Insurance Median

$79

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: $77 (72%)

Insurance Median: $79 (74%)

Cash: $77 (72% of Medicare)

Ins. Median: $79 (74% 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
Comm Blue Essential	$33	31%
Community Blue	$33	31%
Community Care - Bc	$33	31%
Fidelis Care Of New York	$33	31%
Ghi Medical	$33	31%
Gowanda Correctional Fac	$33	31%
Medicaid / KanCare	$33	31%
Molina Essential Plan	$33	31%
Molina Heathcare Of Wny	$33	31%
Seneca Nation Health Dept	$33	31%
United Hc - Community Pln	$33	31%
United Hc Essential Plan	$33	31%
Univera Hc Myhealth	$33	31%
Univera Hc Myhealth+	$33 - $88	31%
Yourcare	$33	31%
Private Pay	$42 - $112	39%
Aetna	$50 - $132	47%
American Progressive Ins.	$50 - $132	47%
Cigna	$50 - $132	47%
Commercial / Misc	$50 - $132	47%
Global Excel Mgt	$50 - $132	47%
Guardian Life Ins. Co.	$50 - $132	47%
Mvp Commercial	$50 - $132	47%
No Amer Meritian Health	$50 - $132	47%
No-Fault	$50 - $132	47%
Blue Cross Blue Shield	$76 - $82	71%
Senior Blue - Bc	$76	71%
Iha Essential Plans	$82 - $91	77%
Iha Medisource	$82 - $91	77%
Univera Essential Plans	$88	82%
Univera Hc Child Health+	$88	82%
Univera Plus Med	$88	82%
Univera Senior Choice	$103	96%
Univera Healthcare	$124	116%
Fidelis Essential Plans	$125	117%
Iha Encompass 65	$127	119%
Iha	$131	123%
Iha Custom Coverage	$131	123%

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 $77.
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 Bertrand Chaffee 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.