CMS Price Transparency Data

Ultrasound, pelvis

Facility: Ira Davenport Memorial Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $633
Cash Discount Price: $658
vs. Medicare Baseline: 5.93x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Ira Davenport Memorial Hospital is $633. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $658. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.93x the Medicare baseline. Located in 7571 State Route 54, Bath, NY.

Cash / Self-Pay

$658

Average discount available for prompt cash payment at this facility.

Insurance Median

$633

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: $658 (616%)

Insurance Median: $633 (593%)

Cash: $658 (616% of Medicare)

Ins. Median: $633 (593% 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 593% of the Medicare baseline (a markup of 493%). 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
Empire	$25 - $96	23%
Blue Cross Blue Shield	$112 - $3,302	105%
Fidelis	$112	105%
Humana	$126 - $980	118%
Tricare	$126	118%
Amerihealth Caritas Mcr Adv - All Plans	$127	119%
Fidelis Care - Exchange - All Plans	$599	561%
Geisinger - All Plans	$633	593%
Cigna	$678	635%
Mvp Health Plan - All Plans	$678	635%
Independent Health - All Plans	$707	662%
Upmc - All Plans	$751	703%
Pomco Inc - All Plans	$784	734%
Aetna	$816 - $971	764%
UnitedHealthcare	$816 - $1,143	764%
Emblem Health - All Plans	$958	897%
Emblem/Ghi	$1,006	942%
Martins Point - All Plans	$1,088	1019%
Healthnow - All Plans	$3,585	3356%

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 $658.
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 Ira Davenport 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.